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`NOVARTIS 2062
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`1
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`11/10/2017
`
`Functional Systems Scores (FSS) and Expanded Disability Status Scale (EDSS) : National Multiple Sclerosis Society
`
`clinical studies in M8, for example, the MSFC. However, since the EDSS represents a familiar and
`widely used albeit imperfect standard, it will probably remain an important part of clinical assessment in
`MS for the foreseeable future.
`
`Psychometric Properties
`
`Both test-retest reliability and inter-rater agreement have varied considerably from study to study with
`some studies finding high values and other studies unacceptably low figures (Coulthard-Morris, 2000). In
`most studies, the distribution of scores on the EDSS forms a bimodal distribution with peaks in the lower
`and upper ranges and a trough in the middle. (Hohol et al, 1995) Scores on the lower end of the EDSS
`are more dependent upon nuances in the neurological examination; those in the middle range are more
`dependent upon gait, while those in the upper (more impaired) range are also dependent upon activities
`of daily living. Since the EDSS is an ordinal rating scale, a 1-point difference in one part of the scale
`does not represent the same interval as a 1-point difference in another part of the scale, thus making
`change or group differences difficult to interpret. Most importantly, there is evidence that the EDSS lacks
`adequate sensitivity to fluctuations in MS-related impairment. (Rudick et al, 1996)
`
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`Many investigators have attempted to correct some of the problems mentioned above by making
`changes in the F88 and EDSS. See for example Goodkin et al (1992). As a result, there have been
`several different versions of the F88 and EDSS, many of which have been used in clinical trials but not
`published. The version presented here is the one originally published by Kurtzke (1983) with some
`explanatory material added when the F88 and EDSS were incorporated in the Minimal Record of
`Disability by the World Health Organization. (Haber and LaRocca, 1985)
`
`https://www.nationalmssociety.org/For-Professionals/Researchers/Resou rces-for-Researchers/Clinical-Study-Measu res/Functional-Systems-Scores-(F. ..
`
`2/2
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`Kurtzke Expanded Disability Status Scale (EDSS)
`
`
` 0.0 - Normal neurological exam (all grade 0 in all Functional System (FS) scores*).
`
` 1.0 - No disability, minimal signs in one FS* (i.e., grade 1).
`
` 1.5 - No disability, minimal signs in more than one FS* (more than 1 FS grade 1).
` 2.0 - Minimal disability in one FS (one FS grade 2, others 0 or 1).
`
` 2.5 - Minimal disability in two FS (two FS grade 2, others 0 or 1).
`
` 3.0 - Moderate disability in one FS (one FS grade 3, others 0 or 1) or mild disability in three or
`four FS (three or four FS grade 2, others 0 or 1) though fully ambulatory.
` 3.5 - Fully ambulatory but with moderate disability in one FS (one grade 3) and one or two FS
`grade 2; or two FS grade 3 (others 0 or 1) or five grade 2 (others 0 or 1).
`
` 4.0 - Fully ambulatory without aid, self-sufficient, up and about some 12 hours a day despite
`relatively severe disability consisting of one FS grade 4 (others 0 or 1), or combination of
`lesser grades exceeding limits of previous steps; able to walk without aid or rest some 500
`meters.
`
` 4.5 - Fully ambulatory without aid, up and about much of the day, able to work a full day, may
`otherwise have some limitation of full activity or require minimal assistance; characterized
`by relatively severe disability usually consisting of one FS grade 4 (others or 1) or
`combinations of lesser grades exceeding limits of previous steps; able to walk without aid
`or rest some 300 meters.
` 5.0 - Ambulatory without aid or rest for about 200 meters; disability severe enough to impair
`full daily activities (e.g., to work a full day without special provisions); (Usual FS
`equivalents are one grade 5 alone, others 0 or 1; or combinations of lesser grades usually
`exceeding specifications for step 4.0).
` 5.5 - Ambulatory without aid for about 100 meters; disability severe enough to preclude full
`daily activities; (Usual FS equivalents are one grade 5 alone, others 0 or 1; or combination
`of lesser grades usually exceeding those for step 4.0).
`
` 6.0 - Intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about
`100 meters with or without resting; (Usual FS equivalents are combinations with more than
`two FS grade 3+).
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
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` ❏
`
`
`
`3
`
`

`

`❏ 6.5 - Constant bilateral assistance (canes, crutches, braces) required to walk about 20 meters
`without resting; (Usual FS equivalents are combinations with more than two FS grade
`3+).
`
`
`*Excludes cerebral function grade 1.
`
`Note 1: EDSS steps 1.0 to 4.5 refer to patients who are fully ambulatory and the precise step
`number is defined by the Functional System score(s). EDSS steps 5.0 to 9.5 are defined by
`the impairment to ambulation and usual equivalents in Functional Systems scores are
`provided.
`
`
`Note 2: EDSS should not change by 1.0 step unless there is a change in the same direction of at
`least one step in at least one FS.
`
`
`
`
`Sources: Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
`Neurology. 1983 Nov;33(11):1444-52.
`
`
` Haber A, LaRocca NG. eds. Minimal Record of Disability for multiple sclerosis. New York: National Multiple
`Sclerosis Society; 1985.
`
` 7.0 - Unable to walk beyond approximately 5 meters even with aid, essentially restricted to
`wheelchair; wheels self in standard wheelchair and transfers alone; up and about in
`wheelchair some 12 hours a day; (Usual FS equivalents are combinations with more than
`one FS grade 4+; very rarely pyramidal grade 5 alone).
`
` 7.5 - Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer;
`wheels self but cannot carry on in standard wheelchair a full day; May require motorized
`wheelchair; (Usual FS equivalents are combinations with more than one FS grade 4+).
`
` 8.0 - Essentially restricted to bed or chair or perambulated in wheelchair, but may be out of
`bed itself much of the day; retains many self-care functions; generally has effective use of
`arms; (Usual FS equivalents are combinations, generally grade 4+ in several systems).
`
` 8.5 - Essentially restricted to bed much of day; has some effective use of arm(s); retains some
`self-care functions; (Usual FS equivalents are combinations, generally 4+ in several
`systems).
`
` 9.0 - Helpless bed patient; can communicate and eat; (Usual FS equivalents are
`combinations, mostly grade 4+).
`
` 9.5 - Totally helpless bed patient; unable to communicate effectively or eat/swallow; (Usual FS
`equivalents are combinations, almost all grade 4+).
`
` 10.0 - Death due to MS.
`
`
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
` ❏
`
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`4
`
`