Multiple Sclerosis Functional Composite (MSFC): Difference between revisions

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# Cognitive function  
# Cognitive function  
Performed with in 20 minutes.
Performed with in 20 minutes.
==== Required equipment ====
* Measured 25-foot walkway
* 9HPT kit
* PASAT audiotape
* Stopwatch
* Forms to record data
* Calculator
{| class="wikitable"
{| class="wikitable"
|+'''Three Functional domains'''
|+'''Three Functional domains'''
|-
|-
|(PASAT)Paced auditory serial addition task
|[[Nine-Hole Peg Test]]
|PASAT  was originally included to cover the cognitive domain. It measures processing speed and working memory, both of which are frequently affected functions in MS patients<ref name=":1" />. PASAT-3 is the last test included in MSFC, which is a measure of cognitive function, enabling the assessment of concentration, speed of auditory information processing, flexibility and calculation. A total of sixty single digit numbers are presented by an audiotape/CD-rom at a constant rate in every 3 seconds (PASAT-3). Patient is required to add each new number to the one immediately prior to it. Due to the relative complexity of this test, a practice trial with a set of 10 numbers should be performed prior to the original test. The patient is allowed up to three practice trials. At east two correct answers on any three trials is sufficient to proceed with the original test. Two sets of numbers (forms A and B) have been developed to be used alternatively in every visit to minimize memorizing. The number of correct answers is recorded. PASAT-2 (stimuli every 2 seconds) test might be administered after PASAT-3 if desired.
|It is a quantitative measure of hand function and is tested with the nine-hole peg test<ref name=":1" />.  
The patient is instructed to arrange pegs into nine holes in a board by both dominant and non-dominant hands in '''two consecutive trials''' for each hand.  
The amount of time (in seconds) required to place and remove all nine pegs is recorded for each trial<ref name=":2">Tiftikçioğlu B. İ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278631/ Multiple Sclerosis Functional Composite (MSFC): Scoring Instructions.] 55(Suppl 1), S46–S48. <nowiki>https://doi.org/10.29399/npa.23330</nowiki>. Noro psikiyatri arsivi. 2014;55(1):46–48.</ref>.
|-
|-
|Timed 25-foot walk test (T25W)
|Timed 25-foot walk test (T25W)
|The ambulatory function is tested with the timed 25-foot walk test (T25W).  The T25W is a reliable test for patients with more severe gait impairment, because it primarily assesses walking speed<ref name=":1" />.
|The timed 25-foot walk test (T25W) is a quantitative measure of ambulation.  The T25W is a reliable test for patients with more severe gait impairment because it primarily assesses walking speed<ref name=":1" />.  
T25W is a quantitative measure of lower extremity function and ambulation. The patient is instructed to walk a distance of 25 feet (7.62 meters), clearly marked at both ends with prominent signs, as quickly as possible, but safely. It should be noted if the patient requires his/her assistive device for walking. As the patient completes first timed walk (Trial 1), he/she is instructed to walk the way back to the starting point (Trial 2). The amount of time required for walking this standard distance in both trials is recorded in seconds. Time limit per trial is 180 seconds (3 minutes). If the patient cannot complete a trial in 3 minutes, or completes the first trial but cannot complete trial 2 after a 5-minute rest period, then the test is discontinued
The patient is instructed to walk a distance of 25 feet as quickly as possible. Both ends are marked with prominent signs. Note, if the patient requires his/her assistive device while walking. As the patient completes trail 1 he/she is instructed to walk back to the starting point (Trial 2). The time will be recorded in seconds in both trials<ref name=":2" />.  
Time limit = 180 seconds (3 minutes)<ref name=":2" />.
 
Discontinued =  Patient is unable to complete a trial in 3 minutes or completes the first trial but cannot complete trial 2 after a 5-minute rest period<ref name=":2" />.
|-
|-
|[[Nine-Hole Peg Test]]
|(PASAT)Paced auditory serial addition task
|It is a quantitative measure of hand function and is tested with the nine-hole peg test<ref name=":1" />. The patient is instructed to arrange pegs into nine holes in a board by both dominant and non-dominant hands in '''two consecutive trials''' for each hand. The amount of time (in seconds) required to place and remove all nine pegs is recorded for each trial.
|PASAT  was originally included to cover the cognitive domain. It measures processing speed and working memory(concentration, speed of auditory, information processing, flexibility and calculation) in MS patients<ref name=":1" />.  
A total of sixty single-digit numbers are presented by an audiotape at a constant rate every 3 seconds.
The patient is instructed to add each new number to the one immediately before it.
The patient is allowed up to three practice trials, two of the correct answers on any three trials are sufficient to proceed with the original test. Two sets of numbers have been designed to be used alternatively in every visit to minimize memorizing.
The test score (out of 60)is the number of correct sums given<ref name=":2" />.
|}
|}




The results of the tests that assess these domains are depicted in an interval scale (seconds or number of correct responses) and can be converted to a ''Z'' score that is based on values of a reference population. An overall score can be calculated by averaging the ''Z'' score of the subtests<ref name=":1" />.
The results of the tests are depicted in an interval scale (seconds or number of correct responses) and can be converted to a ''Z'' score that is based on values of a reference population. An overall score can be calculated by averaging the ''Z'' score of the subtests<ref name=":1" />.


==Evidence==
==Evidence==


It has good intra- and inter-rater reliability and it results in a score on a continuous scale.
It has good intra- and inter-rater reliability and it results in a score on a continuous scale<ref name=":1" />.
 
'''Excellent''' test-retest reliability (ICC = 0.96)<ref>Cohen, J. A., Fischer, J. S., et al. . [https://pubmed.ncbi.nlm.nih.gov/10690966/ “Intrarater and interrater reliability of the MS functional composite outcome measure.”]  54(4): 802-806. Neurology [Internet]. 1994;54(4):802–806. Available from: <nowiki>https://pubmed.ncbi.nlm.nih.gov/10690966/</nowiki></ref>


==Resources==
==Resources==

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Purpose[edit | edit source]

The Multiple Sclerosis Functional Composite (MSFC) designed by "National MS Society's Clinical Outcome Assessment Task" and is a standardized tool used to quantify degree of disability in patients with multiple sclerosis (MS)[1]. Limitations in Expanded Disability Status Scale leads to development of MSFC in the early 1990's, to improve clinical assessment of patients with multiple sclerosis[2][3]. The traditional scales such as EDSS scale are inadequate in measuring some key aspects of MS for example cognitive function and have psychometric limitations as well[1].

Technique[edit | edit source]

MSFC covers three functional domains[3]:

  1. Ambulatory Function
  2. Hand Function
  3. Cognitive function

Performed with in 20 minutes.

Required equipment[edit | edit source]

  • Measured 25-foot walkway
  • 9HPT kit
  • PASAT audiotape
  • Stopwatch
  • Forms to record data
  • Calculator
Three Functional domains
Nine-Hole Peg Test It is a quantitative measure of hand function and is tested with the nine-hole peg test[3].

The patient is instructed to arrange pegs into nine holes in a board by both dominant and non-dominant hands in two consecutive trials for each hand. The amount of time (in seconds) required to place and remove all nine pegs is recorded for each trial[4].

Timed 25-foot walk test (T25W) The timed 25-foot walk test (T25W) is a quantitative measure of ambulation. The T25W is a reliable test for patients with more severe gait impairment because it primarily assesses walking speed[3].

The patient is instructed to walk a distance of 25 feet as quickly as possible. Both ends are marked with prominent signs. Note, if the patient requires his/her assistive device while walking. As the patient completes trail 1 he/she is instructed to walk back to the starting point (Trial 2). The time will be recorded in seconds in both trials[4]. Time limit = 180 seconds (3 minutes)[4].

Discontinued = Patient is unable to complete a trial in 3 minutes or completes the first trial but cannot complete trial 2 after a 5-minute rest period[4].

(PASAT)Paced auditory serial addition task PASAT was originally included to cover the cognitive domain. It measures processing speed and working memory(concentration, speed of auditory, information processing, flexibility and calculation) in MS patients[3].

A total of sixty single-digit numbers are presented by an audiotape at a constant rate every 3 seconds. The patient is instructed to add each new number to the one immediately before it. The patient is allowed up to three practice trials, two of the correct answers on any three trials are sufficient to proceed with the original test. Two sets of numbers have been designed to be used alternatively in every visit to minimize memorizing. The test score (out of 60)is the number of correct sums given[4].


The results of the tests are depicted in an interval scale (seconds or number of correct responses) and can be converted to a Z score that is based on values of a reference population. An overall score can be calculated by averaging the Z score of the subtests[3].

Evidence[edit | edit source]

It has good intra- and inter-rater reliability and it results in a score on a continuous scale[3].

Excellent test-retest reliability (ICC = 0.96)[5]

Resources[edit | edit source]

Guidebook

Scoring guideline

References[edit | edit source]

  1. ↑ 1.0 1.1 JS, RA, GR, SC. F Rudick, Cutter, Reingold. The Multiple Sclerosis Functional Composite measure (MSFC): an integrated approach to MS clinical outcome assessment. Multiple Sclerosis Journal [Internet]. 1999 [cited 2024 Mar 1];5(4):244–250.
  2. ↑ Cutter GR, Baier ML, Rudick RA, Cookfair DL, Fischer JS, Petkau J, . Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain [Internet]. 1999 [cited 2024 Mar 1];122(5):871–882.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Van Munster, C. E., & Uitdehaag, B. M. Outcome Measures in Clinical Trials for Multiple Sclerosis. CNS drugs. 2017;31(3):217–236.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Tiftikçioğlu B. İ. Multiple Sclerosis Functional Composite (MSFC): Scoring Instructions. 55(Suppl 1), S46–S48. https://doi.org/10.29399/npa.23330. Noro psikiyatri arsivi. 2014;55(1):46–48.
  5. ↑ Cohen, J. A., Fischer, J. S., et al. . “Intrarater and interrater reliability of the MS functional composite outcome measure.”  54(4): 802-806. Neurology [Internet]. 1994;54(4):802–806. Available from: https://pubmed.ncbi.nlm.nih.gov/10690966/
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