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The patient knows best; significant change in the physical component of the multiple sclerosis impact scale (MSIS-29 physical)
  1. Lisa Costelloe (l.costelloe{at}st-vincents.ie)
  1. St Vincent's University Hospital, Republic of Ireland
    1. Killian O'Rourke (killian.orourke{at}gmail.com)
    1. St Vincent's University Hospital, Republic of Ireland
      1. Hugh Kearney (h.kearney{at}st-vincents.ie)
      1. St Vincent's University Hospital, Republic of Ireland
        1. Christopher McGuigan (cmcguigan{at}doctors.org.uk)
        1. St Vincent's University Hospital, Republic of Ireland
          1. Lisa Gribbin (l.gribbin{at}st-vincents.ie)
          1. St Vincent's University Hospital, Republic of Ireland
            1. Marguerite Duggan (m.duggan{at}st-vincents.ie)
            1. St Vincent's University Hospital, Republic of Ireland
              1. Niall Tubridy (n.tubridy{at}st-vincents.ie)
              1. St Vincent's University Hospital, Republic of Ireland
                1. Leslie Daly (leslie.daly{at}ucd.ie)
                1. School of Public Health and Population Science, University College Dublin, Republic of Ireland
                  1. Michael Hutchinson (mhutchin{at}iol.ie)
                  1. St Vincent's University Hospital, Republic of Ireland

                    Abstract

                    Introduction and aims: The aims of this study were to determine the reliability, responsiveness and minimally important change score of the MSIS-29 physical using the EDSS as an anchor measure.

                    Methods: 214 MS patients (EDSS 0- 8.5) had concurrent MSIS-29 and EDSS assessments at baseline and at up to four years of follow-up.

                    Results: Stable patients. 116 patients had unchanged EDSS scores. Stability of the MSIS-29 physical (mean change 0.1 points) was better in the 85 patients with EDSS 0 to 5.0 than in the 31 patients with EDSS 5.5 to 8.5 in whom the MSIS-29 physical score fell by eight points, a response shift phenomenon. A floor effect for the MSIS-29 was observed in 5% of stable patients at both time points. Changed Patients. 98 patients experienced EDSS change with moderately strong statistically significant correlations between change scores in the EDSS and the MSIS-29 physical (r = 0.523, p< 0.0001). Effect sizes for MSIS-29 physical change were moderate to large. Using ROC curves, the MSIS-29 change score which produced a combination of optimal sensitivity and specificity was chosen for both EDSS ranges. For EDSS range 5.5- 8, a change score of eight had a sensitivity of 87% and specificity of 67%. For EDSS 0- 5.0, a change score of seven had a sensitivity of 78% and a specificity of 51%.

                    Conclusions: The MSIS-29 physical performs well over time, and is suitable for use in trials; a minimal change score of eight points in the MSIS-29 is clinically significant.

                    • disability scales
                    • multiple sclerosis
                    • multiple sclerosis impact scale
                    • response shift
                    • self-report measures

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