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Multiple Sclerosis

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Full Title: Criteria to Determine Disability Related to Multiple Sclerosis

May 2004

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Structured Abstract

Objectives: To identify, review, and evaluate the medical literature on five major topics related to the Social Security Administration's (SSA) multiple sclerosis (MS) disability policies: reliability of MS diagnostic criteria; predictors of physical and mental impairments; effect of treatment and symptom management therapies; association of clinical findings with work ability; and impact of environmental factors on work capacity. Secondarily, to describe information needed to address data insufficiencies, if any, in these five areas.

Data Sources: Nearly 1500 English-language articles were identified, principally from searches of MEDLINE®, CINAHL®, and Web of Science. The term multiple sclerosis was merged with concepts specific to the topic areas.

Review Methods: Articles underwent three levels of screening (titles and abstracts; full-text articles; data abstraction). Inclusion requirements included a population with MS, relevance to specific question(s) based on appropriate thresholds, and satisfactory level of evidence. Descriptive data were partially abstracted into standardized evidence tables by a non-clinician abstractor and then completed by two clinicians (primary abstractor and overreader). Methodological quality of each article was assessed for internal and external validity and reported in the evidence tables.

Results: In two recent high-quality studies, the McDonald criteria identified a high proportion of patients presenting with clinically isolated syndrome who will go on to develop clinically definite MS over 1-4 years of followup, with a specificity of 83 to 87 percent. Few prospective studies described prediction of changes in physical and mental impairments over a 9- to 24-month time frame. In clinical trials, few patients improved with disease-modifying treatments and then only in the range of 1.0 point on the Extended Disability Status Scale (EDSS); rehabilitation and symptomatic treatment of spasticity, fatigue, depression, voiding dysfunction, and cognitive impairments resulted in symptom and functional status improvement. Work ability has been little studied, and few data link it to symptoms or objective physical and cognitive measures. None of the examined studies linked thermal sensitivity and workability.

Conclusions: McDonald criteria appear to have substantial evidence for validity and interrater reliability in diagnosing MS; clinical data are poor at predicting 1-year clinical outcomes. Treatments do not result in improvements in impairments, but symptomatic treatments can result in improvements in functional status. Further research is required to understand the associations between clinical data and work status or work ability.

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Criteria to Determine Disability Related to Multiple Sclerosis

Evidence-based Practice Center: Duke University
Topic Nominator: Social Security Administration

Current as of May 2004


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