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Department of Clinical Neurological Sciences (Dr. Noseworthy, Ms. Vandervoort, and Dr. Ebers), University of Western Ontario, and the Roberts Research Institute (Ms. Wong), London, ON, Canada.
We describe the interrater variability in the Expanded Disability Status Scale (EDSS) and Functional Systems (FS) in a multiple sclerosis clinical trial. Two physicians blinded to their previous assessments and to each other's scores consecutively examined 168 patients (545 paired examinations). Perfect agreement on the assignment of the disability scores ranged from 48% (cerebellar functional group) to 69% (EDSS and pyramidal functional group). Only 31% to 62% of this agreement occurred independently of that expected by chance (kappa). With the exception of the cerebellar and sensory functional groups, agreement within 1 step occurred in at least 92% of cases. These findings suggest that differences of a single step on these scales may not reflect an important functional change. We recommend that at least a 2-step change (1.0 point on the EDSS and 2 points on the FS) is needed to be confident of an important change in the degree of disability or response to treatment in this disease.
Address correspondence and reprint requests to Dr. John H. Noseworthy, Department of Clinical Neurological Sciences, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada.
Supported by a grant from the Medical Research Council of Canada. Dr. Noseworthy is the recipient of a Career Development Award from the Multiple Sclerosis Society of Canada. Dr. Ebers is a Career Investigator of the Ontario Ministry of Health.
Presented in part at the 40th annual meeting of the American Academy of Neurology, Cincinnati, OH, April 1988.
The Canadian Cooperative Multiple Sclerosis Study Group consists of the following investigators, committees, and participating centers (members of the executive committee are indicated by an asterisk): Central Coordinating Centre (University of Western Ontario), London, O N principal investigator J.H. NoseworthyL; study coordinator M.K. Vandervoort*; safety committee: R. Roberts, chainaan, Hamilton, ON, J.P. Antel, Montreal, PQ. J.F. Kurtzke, Washington, DC. Participating centers (in order of number of eligible patients entered): University of Western Ontario, London, ON—J.H. Noseworthf, M.K. Vandervoort*, W.P. Mcinnis, G.C. Ebers*, G.P.A. Rice, B.G. Weinshenker, D. Hollomby, and N. Muirhead; The University of Calgary, Calgary, AB—T.P. Seland, co-director*, 0. Suchowersky, C. Harris, and J. Klassen; University of Manitoba, Winnipeg, MB—A. Auty, J.M. Del Campo, J. Todd, and H. Rayner, University of British Columbia, Vancouver, BC—D. Paty, S. Hashimoto, R. Farquhar, K. Eiaen, and W.B. Benny; University of Toronto, Toronto, ON—T. Gray, G. Sawa, K.H. Shumak*, A. Royal, E. McBride, and JJ. Freedman; University of Saskatchewan, Saskatoon, SK—DJ. MacFadyen, W. Hader, E. Ashenhurst, M. Schmaltz, D. Sheridan, and R. Card; university of Montreal, Montreal, PQ—P. Duquette. L. Roy. J. Pleines, and Y. Lapoink McMaater University, Hamilton, ON—J.E. Paulseth, R. Lo, M. Gent*, D.W. Taylor*, B. Neufeld, and J.A. McBride; University of Ottawa, Ottawa, ON—R. Nelson, D. Preston, G. Rock, and L. Huebsch.
Received September 25, 1989. Accepted for publication in final form November 16, 1989.
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