Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis

BMC Neurology

Volumn 14, Issue 1, 2014, Pages

  Meyer Moock, Sandra ^a   Feng, You Shan ^a   Maeurer, Mathias ^b   Dippel, Franz Werner ^c   Kohlmann, Thomas ^a  

^a UNIVERSITY MEDICINE GREIFSWALD   (Germany)

^b CARITAS KRANKENHAUS   (Germany)

^c UNIVERSITY OF LEIPZIG   (Germany)

Author keywords

Expanded Disability Status Scale (EDSS); Multiple sclerosis; Multiple Sclerosis Functional Composite (MSFC); Psychometric properties; Reliability; Sensitivity of change; Validity

Indexed keywords

ALEMTUZUMAB; BETA1A INTERFERON; FINGOLIMOD; FUMARIC ACID DIMETHYL ESTER; GLATIRAMER; INTERFERON BETA SERINE; MITOXANTRONE; NATALIZUMAB; TERIFLUNOMIDE;

ARTICLE; DISEASE COURSE; EXPANDED DISABILITY STATUS SCALE; HUMAN; MULTIPLE SCLEROSIS; MULTIPLE SCLEROSIS FUNCTIONAL COMPOSITE; NAMED INVENTORIES, QUESTIONNAIRES AND RATING SCALES; PHASE 3 CLINICAL TRIAL (TOPIC); PHASE 4 CLINICAL TRIAL (TOPIC); PSYCHOMETRY; RELAPSE; RELIABILITY; SYSTEMATIC REVIEW; VALIDITY; CLINICAL TRIAL (TOPIC); DISABILITY; EVALUATION STUDY; METHODOLOGY; PATHOPHYSIOLOGY; REVIEW; STANDARD; VALIDATION STUDY;

CLINICAL TRIALS AS TOPIC; DISABILITY EVALUATION; HUMANS; MULTIPLE SCLEROSIS; PSYCHOMETRICS;

EID: 84898926829     PISSN: None     EISSN: 14712377     Source Type: Journal    
DOI: 10.1186/1471-2377-14-58     Document Type: Article

References (90)

1. Weinshenker BG. The natural history of multiple sclerosis. Clin Neurol Neurosurg 1995, 13:119-146.
2. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale. Neurology 1983, 5:580-583.
3. Cutter GR, Baier ML, Rudick RA, Cookfair DL, Fischer JS, Petkau J, Syndulko K, Weinshenker BG, Antel JP, Confavreux C, Ellison GM, Lublin F, Miller AE, Rao SM, Reingold S, Thompson A, Willoughby A. Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain 1999, 122:871-882. 10.1093/brain/122.5.871, 10355672.
4. Fischer JS, Rudick RA, Cutter GR, Reingold SC. The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome. National MS Society Clinical Outcomes Assessment Task Force. Mult Scler 1999, 5(4):244-250.
5. Baier ML, Cutter GR, Ruck RA. Low-contrast letter acuity testing captures visual dysfunction in patients with multiple sclerosis. Neurology 2005, 64:992-995. 10.1212/01.WNL.0000154521.40686.63, 15781814.
6. Balcer LJ. Clinical outcome measures for research in multiple sclerosis. J Neuroophthalmol 2001, 21:296-301. 10.1097/00041327-200112000-00014, 11756863.
7. Balcer LJ, Baier ML, Cohen JA, Kooijmans MF, Sandrock AW, Nano-Schiavi ML, Pfohl DC, Mills M, Bowen J, Ford C, Heidenreich FR, Jacobs DA, Markowitz CE, Stuart WH, Ying GS, Galetta SL, Maguire MG, Cutter GR. Contrast letter acuity as a visual component for the multiple sclerosis functional composite. Neurology 2003, 61:1367-1373. 10.1212/01.WNL.0000094315.19931.90, 14638957.
8. Drake AS, Weinstock-Guttman B, Morrow SA, Hojnacki D, Munschauer FE, Benedict RH. Psychometrics and normative data for the multiple sclerosis functional composite: replacing the PASAT with the symbol digit modalities test. Mult Scler 2010, 16:228-237. 10.1177/1352458509354552, 20028710.
9. Rudick RA, Polman CH, Cohen JA, Walton MK, Miller AE, Confavreux C, Lublin FD, Hutchinson M, O'Connor PW, Schwid SR, Balcer LJ, Lynn F, Panzara MA, Sandrock AW. Assessing disability progression with the multiple sclerosis functional composite. Mult Scler 2009, 15:984-997. 10.1177/1352458509106212, 19667023.
10. Uitdehaag BMJ, Adèr HJ, Roosma TJ, de Groot V, Kalkers NF, Polman CH. Multiple sclerosis functional composite: impact of reference population and interpretation of changes. Mult Scler 2002, 8:366-371. 10.1191/1352458502ms835oa, 12356201.
11. Bosma L, Kragt JJ, Brieva L, Khaleel Z. The search for responsive clinical endpoints in primary progressive multiple sclerosis. Mult Scler 2009, 15:715-720. 10.1177/1352458509102626, 19383646.
12. Vaney C, Vaney S, Wade DT. SaGAS, the short and graphic ability score: an alternative scoring method for the motor components of the multiple sclerosis functional composite. Mult Scler 2004, 10:231-242. 10.1191/1352458504ms1000oa, 15124771.
13. Nagels G, Geentjens L, Kos D, Vleugels L, D'hooghe MB, Van Asch P, Vuylsteke K, De Deyn PP. Paced visual serial addition test in multiple sclerosis. Clin Neurol Neurosurg 2005, 107:218-222. 10.1016/j.clineuro.2004.11.016, 15823678.
14. Hauser SL, Dawson DM, Lehrich JR, Beal MF, Kevy SV, Propper RD, Mills JA, Weiner HL. Intensive immunosuppression in progressive multiple sclerosis: a randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. N Engl J Med 1983, 308:173-180. 10.1056/NEJM198301273080401, 6294517.
15. Sipe JC, Knobler RL, Braheny SL, Rice GP, Panitch HS, Oldstone MS. A neurologic rating scale (NRS) for use in multiple sclerosis. Neurology 1984, 34:1368-1372. 10.1212/WNL.34.10.1368, 6541311.
16. Mickey MR, Ellison GW, Myers LW. An illness severity score for multiple sclerosis. Neurology 1984, 34:1343-1347. 10.1212/WNL.34.10.1343, 6541306.
17. Sharrack B, Hughes R. The Guy's Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler 1999, 5(4):223-233.
18. Ravnborg M, Grønbech-Jensen M, Jønsson A. The MS-impairment scale: a pragmatic approach to the assessment of impairment in patients with multiple sclerosis. Mult Scler 1997, 3:31-42. 10.1177/135245859700300104, 9160344.
19. Hamilton BB, Granger CV, Shervin FS, Zielezny M, Teshman JS. A uniform national data system for medical rehabilitation. Rehabilitation Outcomes: Analysis and Measurements 1987, 137-147. Baltimore: Brookes, Fuhrer MJ.
20. Mumford CJ, Compston A. Problem with rating scales for multiple sclerosis: a novel approach - the CAMBS score. J Neurol 1993, 240:209-215. 10.1007/BF00818706, 8496708.
21. Noseworthy JH. Clinical scoring methods for multiple sclerosis. Ann Neurol 1994, 36(Supplement):S80-S85.
22. Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res 1995, 4:187-206. 10.1007/BF02260859, 7613530.
23. Ritvo PG, Fischer JS, Miller DM, Andrews H, Paty DW, LaRocca MG. Multiple Sclerosis Quality of Life Inventory (MSQLI): a user's Manual 1997, New York: National Multiple Sclerosis Society.
24. Noseworthy JH, Vandervoort MK, Wong CJ, Ebers GC. Interrater variability with the Expanded Disability Status Scale (EDSS) and Functional Systems (FS) in a multiple sclerosis clinical. Neurology 1990, 40:971-975. 10.1212/WNL.40.6.971, 2189084.
25. Francis DA, Bain P, Swan AV, Hughes RA. An assessment of disability rating scales used in multiple sclerosis. Arch Neurol 1991, 48:299-301. 10.1001/archneur.1991.00530150067020, 2001188.
26. Verdier-Taillefer MH, Zuber M, Lyon-Caen O, Clanet M, Gout O, Louis C, Alpérovitch A. Observer disagreement in rating neurologic impairment in multiple sclerosis: facts and consequences. Eur Neurol 1991, 31:117-119. 10.1159/000116658, 2044616.
27. Goodkin DE, Cookfair D, Wende K, Bourdette D, Pullicino P, Scherokman B, Whitham R. Inter- and intrarater scoring agreement using grades 1.0 to 3.5 of the Kurtzke Expanded Disability Status Scale (EDSS). Neurology 1992, 42:859-863. 10.1212/WNL.42.4.859, 1565242.
28. Marolf MV, Vaney C, Konig N, Schenj T, Prosiegel M. Evaluation of disability in multiple sclerosis patients: a comparative study of the functional independence measure, the extended barthel index and the expanded disability status scale. Clin Rehabil 1996, 10:309-313.
29. Sharrack B, Hughes R, Soudain S, Dunn G. The psychometric properties of clinical rating scales used in multiple sclerosis. Brain J Neurol 1999, 122:141-159.
30. Willoughby EW, Paty DW. Scales for rating impairment in multiple sclerosis: a critique. Neurology 1988, 38:1793-1798. 10.1212/WNL.38.11.1793, 3185917.
31. Amato MP, Ponziani G. Quantification of impairment in MS: discussion of the scales in use. Mult Scler 1999, 5:216-219.
32. Hobart J, Freeman J, Thompson A. Kurtzke scales revisted: the application of psychometric methods to clinical intuition. Brain 2000, 123:1027-1040. 10.1093/brain/123.5.1027, 10775547.
33. Multiple IFNB, Sclerosis Study Group Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993, 43:655-661. Sclerosis Study Group.
34. PRIMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998, 352:1498-1504. 10.1016/S0140-6736(98)03334-0, 9820297, PRIMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group.
35. Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, Fischer JS, Goodkin DE, Granger CV, Simon JH, Alam JJ, Bartoszak DM, Bourdette DN, Braiman J, Brownscheidle CM, Coats ME, Cohan SL, Dougherty DS, Kinkel RP, Mass MK, Munschauer FE, Priore RL, Pullicino PM, Scherokman BJ, Weinstock-Guttman B, Whitham RH. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol 1996, 39:285-294. 10.1002/ana.410390304, 8602746.
36. Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind, placebo-controlled trial. Neurology 1995, 45(7):1268-1276. 10.1212/WNL.45.7.1268, 7617181.
37. Paty DW, Li DK. Interferon beta-1bis effective in relapsing-remitting multiple sclerosis. II. MRI analyses results of a multicenter, randomized, double-blind, placebo-controlled trial UBCMS/MRI study group and the IFNB multiple sclerosis study group. Neurology 1993, 43:622-667. 10.1212/WNL.43.3_Part_1.622, 8451014.
38. Wolinsky JS, Narayana PA, Johnson KP. United-States open-label glatiramer acetate extension trial for relapsing multiple sclerosis: MRI and clinical correlates. Multiple Sclerosis Study Group and the MRI Analysis Center. Mult Scler 2001, 7:33-41.
39. Coles AJ, Compston DA, Selmaj KW, Lake SL, Moran S, Margolin DH, Norris K, Tandon PK. Alemtuzumab vs. interferon beta-1a in early multiple sclerosis. N Engl J Med 2008, 359:1786-1801.
40. Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, Phillips JT, Lublin FD, Giovannoni G, Wajgt A, Toal M, Lynn F, Panzara MA, Sandrock AW, AFFIRM Investigators A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006, 354:899-891. 10.1056/NEJMoa044397, 16510744, AFFIRM Investigators.
41. Rudick RA, Stuart WH, Calabresi PA, Confavreux C, Galetta SL, Radue EW, Lublin FD, Weinstock-Guttman B, Wynn DR, Lynn F, Panzara MA, Sandrock AW, SENTINEL Investigators Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med 2006, 354:911-923. 10.1056/NEJMoa044396, 16510745, SENTINEL Investigators.
42. European Medicines Agency (EMA) Guideline of clinical investigation of medical products for the treatment of Multiple Sclerosis. Draft EMA/CHMP/771815/2011, Rev 2,20 September 2012. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2012/10/WC500133438.pdf, European Medicines Agency (EMA).
43. Amato MP, Groppi C, Siracusa G, Fratiglioni Inter and intra-observer reliability in Kurtzke scoring systems in multiple sclerosis. Ital J Neurol Sci 1987, Supplement 6:129-131. Fratiglioni.
44. Amato MP, Fratiglioni L, Groppi C, Siracusa G, Amaducci L. Interrater reliability in assessing functional systems and disability on the Kurtzke scale in multiple sclerosis. Arch Neurol 1988, 45:746-748. 10.1001/archneur.1988.00520310052017, 3390030.
45. Amato MP, Portaccio E. Clinical outcome measures in multiple sclerosis. J Neurol Sci 2007, 259:118-122. 10.1016/j.jns.2006.06.031, 17376487.
46. Ebers GC, Heigenhauser L, Daumer M, Lederer C, Noseworthy JH. Disability as an outcome in MS clinical trials. Neurology 2008, 71:624-631. 10.1212/01.wnl.0000313034.46883.16, 18480462.
47. Brosseau L, Wolfson C. The inter-rater reliability and construct validity of the functional independence measure for multiple sclerosis subjects. Clin Rehabil 1994, 8:107-115.
48. Rothwell PM, McDowell Z, Wong CK, Dorman PJ. Doctors and patients don't agree: cross sectional study of patient's and doctors' perceptions and assessments of disability in multiple sclerosis. Br Med J 1997, 314:1580-1583.
49. Schwid SR, Goodman AD, Mattson DH, Mihai C, Donohoe KM, Petrie MD, Scheid EA, Dudman JT, McDermott MP. The measurement of ambulatory impairment in multiple sclerosis. Neurology 1997, 49:1419-1424. 10.1212/WNL.49.5.1419, 9371932.
50. Cohen RA, Kessler HR, Fischer M. The Extended Disability Status Scale (EDSS) as a predictor of impairments of functional activities of daily living in multiple-sclerosis. J Neurol Sci 1993, 115:132-135. 10.1016/0022-510X(93)90215-K, 8482974.
51. Gaspari M, Roveda G, Scandellari C, Stecchi S. An expert system for the evaluation of EDSS in multiple sclerosis. Artif Intell Med 2002, 25:187-210. 10.1016/S0933-3657(02)00015-5, 12031606.
52. Cohen JA, Fischer JS, Bolibrush DM, Jak AJ, Kniker JE, Mertz LA, Skaramagas TT, Cutter GR. Intrarater and interrater reliability of the MS functional composite outcome measure. Neurology 2000, 54:802-806. 10.1212/WNL.54.4.802, 10690966.
53. Hohol MJ, Orav EJ, Weiner HL. Disease steps in multiple-sclerosis - a simple approach to evaluate disease progression. Neurology 1995, 45:251-255. 10.1212/WNL.45.2.251, 7854521.
54. Hutchinson J, Hutchinson M. The functional limitations profile may be a valid, reliable and sensitive measure of disability in multiple-sclerosis. J Neurol 1995, 242:650-657. 10.1007/BF00866915, 8568526.
55. Schwid SR, Goodman AD, Apatoff BR, Coyle PK, Jacobs LD, Krupp LB, Miller AE, Wende KE, Brownscheidle CM, New York State Multiple Sclero Are quantitative functional measures more sensitive to worsening MS than traditional measures?. Neurology 2000, 55:1901-1903. 10.1212/WNL.55.12.1901, 11134392, New York State Multiple Sclero.
56. Vaney C, Blaurock H, Gattlen B, Meisels C. Assessing mobility in multiple sclerosis using the rivermead mobility index and gait speed. Clin Rehabil 1996, 10:216-226.
57. Koziol JA, Frutos A, Sipe JC, Romine JS, Beutler E. A comparison of two neurologic scoring instruments for multiple sclerosis. J Neurol 1996, 243:209-213. 10.1007/BF00868516, 8936349.
58. Hohol MJ, Orav EJ, Weiner HL. Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression. Mult Scler 1999, 5:349-354.
59. Ravnborg M, Blinkenberg M, Sellebjerg F, Ballegaard M, Larsen SH, Sørensen PS. Responsiveness of the multiple sclerosis impairment scale in comparison with the expanded disability status scale. Mult Scler 2005, 11:81-84. 10.1191/1352458505ms1120oa, 15732271.
60. Barker-Collo SL. Quality of life in multiple sclerosis: does information-processing speed have an independent effect?. Arch Clin Neuropsychol 2006, 21:167-174. 10.1016/j.acn.2005.08.008, 16242906.
61. Hyland M, Rudick RA. Challenges to clinical trials in multiple sclerosis: outcome measures in the era of disease-modifying drugs. Curr Opin Neurol 2011, 24:255-26. 10.1097/WCO.0b013e3283460542, 21455068.
62. Drulovic J, Riise T, Nortvedt M, Pekmezovic T, Manigoda Self-rated physical health predicts change in disability in multiple sclerosis. Mult Scler 2008, 14:999-1002. 10.1177/1352458508088917, 18505776, Manigoda.
63. Fisk JD, Brown MG, Sketris IS, Metz LM, Murray TJ, Stadnyk KJ. A comparison of health utility measures for the evaluation of multiple sclerosis treatments. J Neurol Neurosurg Psychiatry 2005, 76:58-63. 10.1136/jnnp.2003.017897, 1739294, 15607996.
64. Twork S, Wiesmeth S, Spindler M, Wirtz M, Schipper S, Pöhlau D, Klewer J, Kugler J. Disability status and quality of life in multiple sclerosis: non-linearity of the Expanded Disability Status Scale (EDSS). Health Qual Life Outcomes 2010, 8:55. 10.1186/1477-7525-8-55, 2890700, 20529265.
65. Healy B, Chitnis T, Engler D. Improving power to dect disease progression in multiple sclerosis through alternative analysis strategies. J Neurol 2011, 258:1812-1819. 10.1007/s00415-011-6021-1, 21472497.
66. Goodkin DE. EDSS reliability. Neurology 1991, 41:322. 10.1212/WNL.41.2_Part_1.322, 1992386.
67. Brochet B, Deloire MS, Bonnet M, Salort-Campana E, Ouallet JC, Petry KG, Dousset V. Should SDMT substitute for PASAT in MSFC? A 5-year longitudinal study. Mult Scler J 2008, 14:1242-1249.
68. Kalkers NF, Bergers L, de Groot V, Lazeron RH, van Walderveen MA, Uitdehaag BM, Polman CH, Barkhof F. Concurrent validity of the MS functional composite using MRI as a biological disease marker. Neurology 2001, 56:215-219. 10.1212/WNL.56.2.215, 11160958.
69. Hoogervorst ELJ, Kalkers NF, Cutter GR, Uitdehaag BM, Polman CH. The patient's perception of a (reliable) change in the Multiple Sclerosis Functional Composite. Mult Scler 2004, 10:55-60. 10.1191/1352458504ms972oa, 14760953.
70. Miller DM, Rudick RA, Cutter G, Baier M, Fischer JS. Clinical significance of the multiple sclerosis functional composite: relationship to patient-reported quality of life. Arch Neurol 2000, 57:1319-1324.
71. Ozakbas S, Cagiran I, Ormeci B, Idiman E. Correlations between multiple sclerosis functional composite, expanded disability status scale and health-related quality of life during and after treatment of relapses in patients with multiple sclerosis. J Neurol Sci 2004, 218:3-7. 10.1016/j.jns.2003.09.015, 14759626.
72. Honarmand K, Akbar N, Kou N, Feinstein A. Predicting employment status in multiple sclerosis patients: the utility of the MS functional composite. J Neurol 2011, 258:244-249. 10.1007/s00415-010-5736-8, 20835872.
73. Cohen JA, Reingold SC, Polman CH, Wolinsky JS. Disability outcome measures in multiple sclerosis clinical trials: current status and future prospects. Lancet Neurol 2012, 11:467-476. 10.1016/S1474-4422(12)70059-5, 22516081.
74. Rudick RA, Cutter G, Reinold S. The multiple sclerosis functional composite: a new clinical outcome measure for multiple sclerosis. Mult Scler 2002, 8:359-365. 10.1191/1352458502ms845oa, 12356200.
75. Cohen JA, Cutter GR, Fischer JS, Goodman AD, Heidenreich FR, Jak AJ, Kniker JE, Kooijmans MF, Lull JM, Sandrock AW, Simon JH, Simonian NA, Whitaker JN. Use of the multiple sclerosis functional composite as an outcome measure in a phase 3 clinical trial. Arch Neurol 2001, 58:961-967. 10.1001/archneur.58.6.961, 11405811.
76. Hoogervorst ELJ, Kalkers NF, Uitdehaag BM, Polman CH. A study validating changes in the multiple sclerosis functional composite. Arch Neurol 2002, 59:113-116. 10.1001/archneur.59.1.113, 11790238.
77. Pascual AM, Boscá I, Coret F, Escutia M, Bernat A, Casanova B. Evaluation of response of multiple sclerosis (MS) relapse to oral high-dose methylprednisolone: usefulness of MS functional composite and Expanded Disability Status Scale. Eur J Neurol 2008, 15:284-288. 10.1111/j.1468-1331.2008.02061.x, 18290849.
78. Kalkers NF, de Groot V, Lazeron RH, Killestein J, Adèr HJ, Barkhof F, Lankhorst GJ, Polman CH. MS functional composite - relation to disease phenotype and disability strata. Neurology 2000, 54:1233-1239. 10.1212/WNL.54.6.1233, 10746590.
79. Miller DM, Cohen JA, Kooijmans M, Tsao E, Cutter G, Baier M. Change in clinician-assessed measures of multiple sclerosis and subject-reported quality of life: results from the IMPACT study. Mult Scler 2006, 12:180-186. 10.1191/135248506ms1270oa, 16629421.
80. Rosti-Otajarvi E, Hämäläinen P, Koivisto K, Hokkanen L. The reliability of the MSFC and its components. Acta Neurol Scand 2008, 117:421-427.
81. Schwid SR, Goodman AD, McDermott MP, Bever CF, Cook SD. Quantitative functional measures in MS: What is a reliable change?. Neurology 2002, 58:1294-1296. 10.1212/WNL.58.8.1294, 11971105.
82. Bosma LVAE, Kragt JJ, Brieva L, Khaleeli Z, Montalban X, Polman CH, Thompson AJ, Tintoré M, Uitdehaag BM. Progression on the multiple sclerosis functional composite in multiple sclerosis: what is the optimal cut-off for the three components?. Mult Scler J 2010, 16:862-867.
83. Solari A, Radice D, Manneschi L, Motti L, Montanari E. The multiple sclerosis functional composite: different practice effects in the three test components. J Neurol Sci 2005, 228:71-74. 10.1016/j.jns.2004.09.033, 15607213.
84. Ozakbas S, Ormeci B, Idiman E. Utilization of the multiple sclerosis functional composite in follow-up: relationship to disease phenotype, disability and treatment strategies. J Neurol Sci 2005, 232:65-69. 10.1016/j.jns.2005.01.008, 15850584.
85. Patzold T, Schwengelbeck M, Ossege LM, Malin JP, Sindern E. Changes of the MS functional composite and EDSS during and after treatment of relapses with methylprednisolone in patients with multiple sclerosis. Acta Neurol Scand 2002, 105:164-168.
86. Kragt JJ, van der Linden FA, Nielsen JM, Uitdehaag BM, Polman CH. Clinical impact of 20% worsening on timed 25-foot walk and 9-hole peg test in multiple sclerosis. Mult Scler 2006, 12:594-598. 10.1177/1352458506070768, 17086905.
87. Coo H, Hopman WM, Edgar CM, McBride EV, Brunet DG. The Paced Auditory Serial Addition Test: to what extent is it performed as instructed, and is it associated with disease course?. Mult Scler 2005, 11:85-89. 10.1191/1352458505ms1124oa, 15732272.
88. Fox RJ, Lee JC, Rudick RA. Optimal reference population for the multiple sclerosis functional composite. Mult Scler 2007, 13:909-914. 10.1177/1352458507076950, 17468446.
89. Kaufman M, Moyer D, Norton J. The significant change for the timed 25-foot walk in the multiple sclerosis functional composite. Mult Scler 2000, 6:286-290.
90. Kragt JJ, Nielsen IM, van der Linden FA, Uitdehaag BM, Polman CH. How similar are commonly combined criteria for EDSS progression in multiple sclerosis?. Mult Scler 2006, 12:782-786. 10.1177/1352458506070931, 17263007.