Getting the measure of spasticity in multiple sclerosis: the Multiple Sclerosis Spasticity Scale (MSSS-88)
Getting the measure of spasticity in multiple sclerosis: the Multiple Sclerosis Spasticity Scale (MSSS-88)
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DOI：
10.1093/brain/awh675
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发表时间：
2006-01-01
期刊：
影响因子：
14.5
通讯作者：
Zajicek, JP
中科院分区：
文献类型：
--
作者：
Hobart, JC;Riazi, A;Zajicek, JP
痉挛最常被定义为由于运动节段对感觉输入的反应性放大而导致的肌肉强直性牵张反射的不适当的、速度依赖性的增加。它是上运动神经元综合征的一个组成部分，通常会导致肌肉僵硬和残疾。因此，痉挛可以通过电生理学、生物力学和临床评估来测量，最后一种最常用的是Ashworth量表。这些技术都没有考虑到患者的痉挛经历，也没有考虑到它如何影响人们的日常生活。因此，我们着手构建一个评级量表，以量化痉挛对多发性硬化症患者的影响。定性的方法（深入的病人访谈和焦点小组，专家意见和文献综述）被用来开发一个概念框架的痉挛影响，并产生一个池的项目有可能将这个框架转换成一个评级量表与多个维度。该项目池以问卷的形式向多发性硬化症和痉挛患者样本进行管理。在Rasch分析的指导下，我们为概念框架的每个组成部分构建并验证了评级量表。关于项目选择的决定是基于七个具体分析的整合和同化，包括临床意义，阈值排序，拟合统计和差异项目功能。定性阶段（17名患者访谈，3个焦点小组）生成了144个潜在量表项目和一个概念模型，其中包含8个组件，用于解决症状（肌肉僵硬，疼痛和不适以及肌肉痉挛），身体影响（日常生活活动，步行和身体运动）和心理社会影响（情绪健康，社会功能）。第一次邮寄调查发送给272名多发性硬化症患者，回复率为88%。调查结果支持每个组成部分的规模的发展，但表明，五个项目的反应选项太多了。144项问卷，重新格式化为四个项目的响应选项，管理与四个验证工具的一个独立的样本259人多发性硬化症（响应率78%）。从回应，一个88项文书，8个分量表的开发，满足标准的可靠性和有效性的测量。与其他措施的相关性与预测一致。88项多发性硬化痉挛量表（MSSS-88）是一个可靠和有效的，以患者为基础的，间隔水平的测量痉挛的影响多发性硬化。它有可能推进临床试验和临床实践中的结果测量，并为痉挛的临床评估提供了一个新的视角。
Spasticity is most commonly defined as an inappropriate, velocity dependent, increase in muscle tonic stretch reflexes, due to the amplified reactivity of motor segments to sensory input. It forms one component of the upper motor neuron syndrome and often leads to muscle stiffness and disability. Spasticity can, therefore, be measured through electrophysiological, biomechanical and clinical evaluation, the last most commonly using the Ashworth scale. None of these techniques incorporate the patient experience of spasticity, nor how it affects people's daily lives. Consequently, we set out to construct a rating scale to quantify the perspectives of the impact of spasticity on people with multiple sclerosis. Qualitative methods (in-depth patient interviews and focus groups, expert opinion and literature review) were used to develop a conceptual framework of spasticity impact, and to generate a pool of items with the potential to convert this framework into a rating scale with multiple dimensions. This item pool was administered, in the form of a questionnaire, to a sample of people with multiple sclerosis and spasticity. Guided by Rasch analysis, we constructed and validated a rating scale for each component of the conceptual framework. Decisions regarding item selection were based on the integration and assimilation of seven specific analyses including clinical meaning, ordering of thresholds, fit statistics and differential item functioning. The qualitative phase (17 patient interviews, 3 focus groups) generated 144 potential scale items and a conceptual model with eight components addressing symptoms (muscle stiffness, pain and discomfort and muscle spasms,), physical impact (activities of daily living, walking and body movements) and psychosocial impact (emotional health, social functioning). The first postal survey was sent to 272 people with multiple sclerosis and had a response rate of 88%. Findings supported the development of scales for each component but demonstrated that five item response options were too many. The 144-item questionnaire, reformatted with four-item response options, was administered with four validating instruments to an independent sample of 259 people with multiple sclerosis (response rate 78%). From the responses, an 88-item instrument with eight subscales was developed that satisfied criteria for reliable and valid measurement. Correlations with other measures were consistent with predictions. The 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) is a reliable and valid, patient-based, interval-level measure of the impact of spasticity in multiple sclerosis. It has the potential to advance outcomes measurement in clinical trials and clinical practice, and provides a new perspective in the clinical evaluation of spasticity.