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Rehab Measures: Disease Steps

Link to instrument

 

Title of Assessment

Disease Steps 

Acronym

Instrument Reviewer(s)

Initially reviewed by Susan E. Bennett, PT, DPT, EdD, NCS, MSCS and the MS EDGE task force of the neurology section of the APTA in 2011.

Summary Date

9/23/2013 

Purpose

To assess functional disability in MS patients.

Description

Disease Steps serves as a guide for neurologists in the decision of when to intervene therapeutically and also to observe the patient’s response over time. Classification is based on ambulation status as well as a history of neurologic examination.

The ambulation scale, walking 25 feet, consists of:

  • 0 = Functionally normal with no limitations on activity or lifestyle
  • 1 = Mild disability, mild symptoms or signs
  • 2 = Moderate disability, visible abnormality of gait
  • 3 = Early cane, use of a cane or other form of unilateral support for greater distances, but can walk at least 25 feet without it
  • 4 = Late cane, cane dependent, unable to walk 25 feet without a cane or other form of unilateral support
  • 5 = Bilateral support, requires bilateral support to walk 25 feet
  • 6 = Confined to wheelchair
  • U = Unclassifiable, used for patients who do not fit above classification

The neurological exam performed requires client participation that establishes scores 1-2.

Area of Assessment

Gait 

Body Part

Lower Extremity 

ICF Domain

Body Structure; Body Function 

Domain

 

Assessment Type

Patient Reported Outcomes 

Length of Test

31 to 60 Minutes 

Time to Administer

15 - 35 minutes

Number of Items

Equipment Required

25-foot unobstructed walkway
 

Training Required

No training

Type of training required

no training 

Cost

Free 

Actual Cost

N/A

Age Range

 

Administration Mode

Paper/Pencil 

Diagnosis

Multiple Sclerosis 

Populations Tested

Multiple Sclerosis Not Established

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Multiple Sclerosis:

(Hohol et al., 1999)

  • Median staying time at a specific level was 12 months

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Multiple Sclerosis:

(Hohol et al., 1995)

  • Excellent interrater reliability (Kappa = 0.8)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Hohol et al., 1995)

  • Excellent correlation between Disease Steps and the EDSS (Spearman’s coefficient = 0.958)

(Hohol et al., 1999)

  • Excellent correlation between Disease Steps scores and EDSS (r = 0.944)
  • Excellent correlation between change in Disease Steps scores and change in EDSS: at 2 years (r = 0.635) and at 3 years (r = 0.622)
  • Adequate correlation between change in Disease Steps scores and change in EDSS at 1 year ( r = 0.545)

Construct Validity (Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

R

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

Yes

No

No

Considerations

Disease Steps is heavily weighted towards ambulation. Unclassifiable patients include individuals with severe visual impairment, overwhelming fatigue, significant bowel or bladder involvement, or severe cognitive impairment in patients with otherwise minor physical disability.

Disease Steps may be more sensitive for patients who use unilateral support.

May not capture acute attacks and does not incorporate measures of disease activity such as attack frequency.

May not be for a skilled nursing facility as a majority of patients there would be a 6 on the scale.

Scale is specific to MS and strongly correlates with the EDSS gold standard.

Recommended for EDSS 0.0-9.5.

Recommended for entry-level curricula.

Not recommended for research purposes; possible limited objectivity with the scale. More objective scales include Timed 25’ Walk, 2- or 6-minute Walk, or 5 Times Sit to Stand.

Bibliography

Hohol, M. J., Orav, E. J., et al. (1995). "Disease steps in multiple sclerosis: a simple approach to evaluate disease progression." Neurology 45(2): 251-255. Find it on PubMed 

Hohol, M. J., Orav, E. J., et al. (1999). "Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression." Mult Scler 5(5): 349-354. Find it on PubMed

Year published

1995 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 2/21/2014 2:05 PM  by Jason Raad 
Last modified at 11/20/2014 2:45 PM  by Jason Raad