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Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis

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      The Patient Determined Disease Steps (PDDS) is a promising patient-reported outcome (PRO) of disability in multiple sclerosis (MS). To date, there is limited evidence regarding the validity of PDDS scores, despite its sound conceptual development and broad inclusion in MS research. This study examined the validity of the PDDS based on (1) the association with Expanded Disability Status Scale (EDSS) scores and (2) the pattern of associations between PDDS and EDSS scores with Functional System (FS) scores as well as ambulatory and other outcomes.


      96 persons with MS provided demographic/clinical information, completed the PDDS and other PROs including the Multiple Sclerosis Walking Scale-12 (MSWS-12), and underwent a neurological examination for generating FS and EDSS scores. Participants completed assessments of cognition, ambulation including the 6-minute walk (6 MW), and wore an accelerometer during waking hours over seven days.


      There was a strong correlation between EDSS and PDDS scores ( ρ = .783). PDDS and EDSS scores were strongly correlated with Pyramidal ( ρ = .578 & ρ = .647, respectively) and Cerebellar ( ρ = .501 & ρ = .528, respectively) FS scores as well as 6 MW distance ( ρ = .704 & ρ = .805, respectively), MSWS-12 scores ( ρ = .801 & ρ = .729, respectively), and accelerometer steps/day ( ρ = -.740 & ρ = -.717, respectively).


      This study provides novel evidence supporting the PDDS as valid PRO of disability in MS.

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      Most cited references 30

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      One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
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          The need for a measure of severity of concussion apart from duration of post-traumatic amnesia is examined. The paced auditory serial-addition test, a measure of rate of information processing, is presented as a convenient test for estimating individual performance during recovery. Procedures for administration and control data are given, and the programme used for managing the rehabilitation of concussion patients described.

            Author and article information

            [1 ]Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
            [2 ]College of Medicine, University of Illinois at Peoria, Peoria, IL, USA
            [3 ]Illinois Neurological Institute, Peoria, IL, USA
            [4 ]Biogen Idec, Weston, MA, USA
            BMC Neurol
            BMC Neurol
            BMC Neurology
            BioMed Central
            25 April 2013
            : 13
            : 37
            23617555 3651716 1471-2377-13-37 10.1186/1471-2377-13-37
            Copyright ©2013 Learmonth et al.; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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