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Assessment of physical functioning in ambulatory persons with multiple sclerosis

Aspects of reliability, responsiveness, and clinical usefulness in the ICF framework

Sammelwerk / Reihe:

Studies in social security and health


Paltamaa, Jaana


The Social Insurance Institution, Finland


Helsinki: Eigenverlag, 2008, 140 Seiten: PDF, ISBN: 978-951-669-764-5 (Print); 978-951-669-765-2 (PDF)




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The main aim of this thesis was to examine the psychometric properties of existing physical functioning measures and to assess the clinical usefulness of the measures in ambulatory persons with MS (PwMS).

The International Classification of Functioning, Disability and Health (ICF) was used as a framework for the study. Participants were obtained from a population-based cohort of PwMS (n = 277) living in Central Finland in 2000. High proportion of the 240 PwMS who answered the questionnaire reported a fairly good level of physical functioning. The high reliability scores found showed that the selected clinical measures of physical functioning could be used with confidence in ambulatory PwMS. These measures
along with self-reported performance in self-care, mobility, and domestic life were used in a 2-year prospective longitudinal study (n = 120). The predictors of self-reported performance were identified using multinomial logistic regression.

The results revealed the value of the clinical outcome measures in detecting minor decrements in functioning that precede and often predict the onset of detectable dependence in performance. In particular, the clinical measures in the ICF activities component predicted poor performance. During the 2-year follow-up, 51% of PwMS reported deterioration compared to the 26% rated as deteriorated by the clinician. Clinically meaningful change was described using multiple anchor- and distribution-based estimates.

The thesis provides recommendations for reliable, responsive and clinically useful physical functioning measures suitable for assessing ambulatory PwMS. Assessment for reducing or postponing functional limitations needs to be extended to those who are independent but perceive difficulties in performance. By using responsive measures it is possible to identify early decline and plan interventions to maintain functioning.

The ICF was found to be helpful in supplementing the information provided by the measures and in describing the physical functioning of ambulatory PwMS.

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The Social Insurance Institution of Finland
Research Department

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Informationsstand: 01.07.2011

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