Authors' objectives:

Our first major objective was to identify, review, and evaluate the medical literature on five major topics: reliability of MS diagnostic criteria; predictors of physical and mental impairments; effect of treatment and symptom management therapies; association of clinical findings with work ability; and impact of environmental factors on work capacity. Our second objective was to describe information needed to address any data insufficiencies, if any, in these five areas.

Authors' results and conclusions: In two recent high-quality studies, the McDonald criteria identified a high proportion of patients presenting with clinically isolated syndrome who will go on to develop clinically definite MS over 1-4 years of follow up, with a specificity of 83 to 87 percent. We found few prospective studies describing prediction of changes in physical and mental impairments over a 9- to 24-month time frame. In clinical trials, few patients improved with disease-modifying treatments and then only in the range of 1.0 point on the Extended Disability Status Scale (EDSS); rehabilitation and symptomatic treatment of spasticity, fatigue, depression, voiding dysfunction, and cognitive impairments resulted in symptom and functional status improvement. Work ability has been little studied, and few data link it to symptoms or objective physical and cognitive measures. We found no studies linking thermal sensitivity and work ability.

Authors' recommendations: McDonald criteria appear to have substantial evidence for validity and inter-rater reliability in diagnosing MS; clinical data are poor at predicting 1-year clinical outcomes. Treatments do not result in improvements in impairments, but symptomatic treatments can result in improvements in functional status. Further research is required to understand the associations between clinical data and work status or work ability.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/msdistp.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)