Applied Neuropsychology: Adult. 2016 Apr; 24(2): 183-189

SymptoMScreen: A Tool for Rapid Assessment of Symptom Severity in MS Across Multiple Domains.

Rivka Green, Jennifer Kalina, Rachel Ford, Krupa Pandey and Ilya Kister

From the Department of Neurology, Multiple Sclerosis Comprehensive Care Center, New York University Langone Medical Center, New York, NY

  

ABSTRACT

The objective of this study was to describe SymptoMScreen, an in-house developed tool for rapid assessment of MS symptom severity in routine clinical practice, and to validate SymptoMScreen against Performance Scales (PS). MS patients typically experience symptoms in many neurologic domains. A tool that would enable MS patients to efficiently relay their symptom severity across multiple domains to the healthcare providers could lead to improved symptom management. We developed “SymptoMScreen,” a battery of 7-point Likert scales for 12 distinct domains commonly affected by MS: mobility, dexterity, body pain, sensation, bladder function, fatigue, vision, dizziness, cognition, depression, and anxiety. We administered SymptoMScreen and PS scales to consecutive MS patients at a specialty MS Care Center. We assessed the criterion and construct validity of SymptoMScreen by calculating Spearmen rank correlations between the SymptoMScreen composite score and PS composite score, and between SymptoMScreen subscale and the respective PS subscale scores, where applicable. A total of 410 patients with MS (age 46.6 ± 12.9 years; 74% female; mean disease duration 12.2 ± 8.7 years) completed the SymptoMScreen and PSs during their clinic visit. Composite SymptoMScreen score correlated strongly with combined PS score (r = 0.88, p < 0.0001). SymptoMScreen sub scores correlated strongly with the criterion measures of the respective PS (r = 0.69–0.87, p < 0.0001). Test-retest reliability of SymptoMScreen and its subscales was excellent (r = 0.71–0.94, p < .0001). SymptoMScreen is a single-page battery of Likert scales that assesses symptom impact in 12 domains commonly affected in MS. It has excellent criterion and construct validity. SymptoMScreen is patient and clinician friendly, takes approximately one minute to complete, and can help better document, understand, and manage patients’ symptoms in routine clinical practice. SymptoMScreen is freely available to clinicians and researchers.

KEY WORDS: Multiple Sclerosis, scale design, symptom validity testing

 

SUPPLEMENT

We designed SymptoMScreen to quickly and reliably assess patients’ symptom severity across twelve domains commonly affected in Multiple Sclerosis. SymptoMScreen was developed based on patient-report of commonly endorsed symptoms and clinically relevant severity levels, and underwent many revisions. Since our article was published in 2016, the scale has further evolved, and now includes simplified instructions and a reader-friendly, single-page format, as well as an additional domain (see below).

 

SymptoMScreen was designed for the busy clinical practice. Patients fill out symptoMScreen before their appointment, thereby allowing practitioners to quickly review their symptom burden across 12 domains. The clinicians can then focus the patient visit on domains requiring attention and make appropriate recommendations – offer symptomatic therapies, discuss lifestyle modifications, make appropriate referrals to occupational and physical therapy, or psychology and social work services. SymptoMScreen is especially valuable for the “subjective” symptoms related to cognitive impairments, mood disturbances, pain, and bladder dysfunction. These symptoms are often of primary concern to the patient, but are largely invisible on neurologic examination. SymptoMScreen can also be used in clinical practice to track symptom severity over time, in order to assess response to disease-modifying or symptomatic therapy, recovery from relapses, or disease progression (e.g. transitioning from relapsing to a progressive phase).

 

SymptoMScreen has been translated into many languages and is currently used as an outcome measure in national and international clinical trials, such as CASTING trial of Ocrelizumab (Roche) and DISCOMS trial (NCT03073603). SymptoMScreen has also been used in our clinic to compare symptomatology in MS and Neuromylitis Optica (Green et al., 2016); to study the correlation between body mass index and symptom severity (Richter et al., 2017), and other studies (Green & Kister, 2016).

 

In summary, symptoMScreen is a valuable, validated quick screen for common symptoms in MS. It is suitable for a busy clinic setting, as well as for clinical research, and is freely available to researchers and clinicians.

 

References:

Richter B, Cutter G, Pandey K, Mohn J, Bacon TE, Kister I (2017). Body mass index correlates with multiple sclerosis disease and symptom severity in women, but not in men. Neurol Disord Therapy 1: DOI: 10.15761/NDT.1000104

Green, R., & Kister, I. (2016). Which Symptoms Contribute the Most to Health-Related Quality (HRQoL) of Life in MS? Neurology, 86(16), Supplement. P2. 175

Green, R., Nathanson, J., & Kister, I. (2016). Multi-dimensional assessment of symptom severity in matched NMO and MS patients. Multiple Sclerosis Journal, 22(3), supplement, 2016.