AvaliaÃÃo de pacientes com esclerose mÃltipla por meio de escalas de incapacidade

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Patients with multiple sclerosis have varied degrees of disability depending on the damage to the neurological functions and their clinical consequences. However, the measurement of disability can vary according to the clinical scale being used, with prognostic and therapeutic consequences. In order to compare the assessment obtained by the main disability scales used on patients with multiple sclerosis, assessing the physical and psychiatric impact, a cross-sectional case series study was undertaken. Fifty-two multiple sclerosis patients were examined between November 2007 and July 2008 at the âHospital da RestauraÃÃoâ (Recife, Brazil). The disability scales which were used were divided into: related to the physical examination (Expanded Disability Status Scale - EDSS; Neurological Rating Scale - NRS; and Multiple Sclerosis Severity Score â MSSS), related to the functional disability (Multiple Sclerosis Functional Composite â MSFC; Timed 25-foot walk - TFW; 9-hole-peg test - 9-HPT; and Paced Auditory Serial Addiction -PASAT) and those related to the perception of the patient (The Guy s Neurological Disability Scale - GNDS; Multiple Sclerosis Impact Scale - MSIS-29; and Modified Fatigue Impact Scale - MFIS- 21). The female-male ratio was 4.2 to 1; most patients regarded themselves as being of mixed race, the age range was from 20 to 59 years and the level of education was secondary education and above. The most frequent form of the clinical course was relapsing-remitting beginning without clinically isolated syndrome, sensitive or motor symptoms. The form of the clinical course was significantly associated to the length of time of the disease. The scales related to the physical exam (EDSS, NRS and MSSS) and to the functional capacity (MSFC) presented a significant relationship, and diverged among the light and severe groups. The scales related to the perception of the patient, MSIS-29 and MFIS-21, were significantly co-related, however they did not relate to the others. The physical components of the disability scales related to each other, whereas the scales related to the perception of the patient, MSIS-29, MFIS-21 (cognitive) and GNDS (cognition and mood), kept a moderate and significant relationship when the psychological components were taken into consideration. The scales related to the physical exam and to the functional capacity diverge from the scales related to the perception of the pacient. This difference is present when the psychological components of the scales are assessed separately. However, it is not present in the relationships between the physical components. Understanding the assessment tool, therefore, can help understand the relationships between object measurement, the technical limitations of the many methods of assessment and the perception of the clinical consequences of multiple sclerosis.

ASSUNTO(S)

neurological exam neurologia techniques of neurological diagnosis health assessment esclerose mÃltipla avaliaÃÃo neurolÃgica multiple sclerosis tÃcnicas de diagnÃstico neurolÃgico

ACESSO AO ARTIGO

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