The MSFC was developed by the National Multiple Sclerosis Society Task Force to address limitations and unidimensionality of prior existing functional status outcomes such as the EDSS.
3
10-20 minutes
Adolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Kathleen Brandfass, MS, PT and the MS EDGE task force in the neurology section of the APTA in August, 2011.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit:
|
Abbreviations: |
|
|
HR |
Highly Recommend |
|
R |
Recommend |
|
LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
|
NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
|
|
Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
|
MS EDGE |
NR |
R |
R |
HR |
R |
Recommendations based on EDSS Classification:
|
|
EDSS 0.0 – 3.5 |
EDSS 4.0 – 5.5 |
EDSS 6.0 – 7.5 |
EDSS 8.0 – 9.5 |
|
MS EDGE |
R |
R |
R |
R |
Recommendations for entry-level physical therapy education and use in research:
|
|
Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
|
MS EDGE |
No |
Yes |
Yes |
No |
Each component test requires active participation. A lack of ability or motivation to walk, to perform upper extremity function and or to participate in the cognitive test will all contribute to limitations in information.
For research purposes, it is recommended that the reference data be created from baseline data from the sample under study (NMSS Manual). While this provides useful information for Z-score calculation within the sample, it limits the generalizability of the results. Using a broader reference database may improve generalizability, but may result in Z-scores that do not accurately reflect individual performance. Care must be taken in the choice of reference database as information compared to different reference database as information compared to different reference databases can have a marked impact on the MSFC Z-score to the point of altering statistical sensitivity. Although the MSFC was created as a multidimensional measure, it does not measure some important constructs such as vision. Limitations of the PASAT-3 as component of the MSFC have been described. Different versions of the MSFC which include the T25WT, the 9HPT and a different measure of cognitive function was more sensitive than the original MSFC in discriminating impairments in cognition. The MSFC has limited clinical utility (inpatient rehab, home health, skilled nursing and outpatient practice settings). Its use is primarily recommended for research or in population-level clinical care.
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Multiple Sclerosis:
(Hobart J, Bosma LV, Rudick RA, Schwid SR et al, 2004, 2009, 2010, 2002)
Multiple Sclerosis:
(Fisher et al, 2002)
Multiple Sclerosis:
(Cohen et al, 2000)
Multiple Sclerosis:
(Cohen et al, 2000; n = 10 PWMS; mean EDSS = 5.2, range = 3.5 – 6.5)
Multiple Sclerosis:
Correlations between MSFC and EDSS:
(Cohen, Fischer, Hobart, Hoogervorst, Kalkers, Miller et al, 2001, 1999, 2004, 2002, 2001, 2000)
(Kalkers, Kragt, Rudick et al, 2001, 2008, 2001)
(Kalkers et al, 2001)
Correlations between MSFC change and EDSS change:
(Hoogervorst, Cutter et al, 2002, 1999)
(Rudick et al 2001)
(Cutter et al, 1999)
Correlations between the MSFC and MRI findings:
(Kalkers et al, 2001)
(Solari et al, 2005)
(Kalkers et al, 2001)
(Rudick, Kalkers, Fisher et al, 2001, 2001, 2000)
(Rudick et al, 2001)
(Cutter, Fisher et al, 1999, 2000)
MSFC and Other Measures:
(Miller et al, 2000)
(Hoogercorst et al, 2004)
(McGuigan et al, 2004)
Multiple Sclerosis:
(Hobart et al, 2004)
Multiple Sclerosis:
(Solari et al, 2005)
Multiple Sclerosis:
(Kragt et al, 2008; n = 161 with primary progressive MS; EDSS median = 5.0)
Bosma, L., Kragt, J., et al. (2010). "Progression on the Multiple Sclerosis Functional Composite in multiple sclerosis: what is the optimal cut-off for the three components?" Multiple Sclerosis 16(7): 862-867.
Cohen, J. A., Cutter, G. R., et al. (2001). "Use of the multiple sclerosis functional composite as an outcome measure in a phase 3 clinical trial." Archives of neurology 58(6): 961.
Cohen, J. A., Fischer, J. S., et al. (2000). "Intrarater and interrater reliability of the MS functional composite outcome measure." Neurology 54(4): 802-806.
Cutter, G. R., Baier, M. L., et al. (1999). "Development of a multiple sclerosis functional composite as a clinical trial outcome measure." Brain 122(5): 871-882.
Drake, A. S., Weinstock-Guttman, B., et al. (2010). "Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test." Mult Scler 16(2): 228-237.
Fischer, J. S., Rudick, R. A., et al. (1999). "The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force." Mult Scler 5(4): 244-250.
Fisher, E., Rudick, R., et al. (2000). "Relationship between brain atrophy and disability: an 8-year follow-up study of multiple sclerosis patients." Multiple Sclerosis 6(6): 373-377.
Fox, R. J., Lee, J. C., et al. (2007). "Optimal reference population for the multiple sclerosis functional composite." Mult Scler 13(7): 909-914.
Goldman, M. D., Motl, R. W., et al. (2010). "Possible clinical outcome measures for clinical trials in patients with multiple sclerosis." Ther Adv Neurol Disord 3(4): 229-239.
Hobart, J., Kalkers, N., et al. (2004). "Outcome measures for multiple sclerosis clinical trials: relative measurement precision of the Expanded Disability Status Scale and Multiple Sclerosis Functional C omposite." Multiple Sclerosis 10(1): 41-46.
Hoogervorst, E. L., Kalkers, N. F., et al. (2002). "A study validating changes in the multiple sclerosis functional composite." Arch Neurol 59(1): 113-116.
Hoogervorst, E. L. J., Kalkers, N., et al. (2004). "The patient's perception of a (reliable) change in the Multiple Sclerosis Functional C omposite." Multiple Sclerosis 10(1): 55-60.
Kalkers, N., Bergers, E., et al. (2001). "Optimizing the association between disability and biological markers in MS." Neurology 57(7): 1253-1258.
Kalkers, N., Bergers, L., et al. (2001). "Concurrent validity of the MS Functional Composite using MRI as a biological disease marker." Neurology 56(2): 215-219.
Kragt, J. J., Thompson, A. J., et al. (2008). "Responsiveness and predictive value of EDSS and MSFC in primary progressive MS." Neurology 70(13 Pt 2): 1084-1091.
McGuigan, C. and Hutchinson, M. (2004). "The multiple sclerosis impact scale (MSIS-29) is a reliable and sensitive measure." Journal of Neurology, Neurosurgery & Psychiatry 75(2): 266-269.
Miller, D. M., Rudick, R. A., et al. (2000). "Clinical significance of the multiple sclerosis functional composite: relationship to patient-reported quality of life." Arch Neurol 57(9): 1319-1324.
Polman, C. H. and Rudick, R. A. (2010). "The multiple sclerosis functional composite: a clinically meaningful measure of disability." Neurology 74 Suppl 3(17 Supplement 3): S8-15.
Rudick, R., Cutter, G., et al. (2001). "Use of the Multiple Sclerosis Functional Composite to predict disability in relapsing MS." Neurology 56(10): 1324-1330.
Rudick, R., Cutter, G., et al. (2002). "The multiple sclerosis functional composite: a new clinical outcome measure for multiple sclerosis trials." Multiple sclerosis 8(5): 359-365.
Rudick, R. A., Polman, C. H., et al. (2009). "Assessing disability progression with the Multiple Sclerosis Functional Composite." Mult Scler 15(8): 984-997.
Schwid, S., Goodman, A., et al. (2002). "Quantitative functional measures in MS: What is a reliable change?" Neurology 58(8): 1294-1296.
Solari, A., Radice, D., et al. (2005). "The multiple sclerosis functional composite: different practice effects in the three test components." J Neurol Sci 228(1): 71-74.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.