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Cover of Criteria to Determine Disability Related to Multiple Sclerosis

Criteria to Determine Disability Related to Multiple Sclerosis

Evidence Reports/Technology Assessments, No. 100

Investigators: , MD, MHS, , PhD, COHN-S, , MD, , MD, MPH, , DPhil, , MA, and , MD.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 04-E019-2ISBN-10: 1-58763-152-0

Structured Abstract


The Social Security Administration (SSA) processes more than 3.5 million claims for disability benefits each year. Multiple sclerosis (MS) is the third most common neurological diagnosis cited as the cause for disability. SSA requested evidence on whether current medical knowledge supports its MS disability policies.


Our first major objective was to identify, review, and evaluate the medical literature on five major topics: reliability of MS diagnostic criteria; predictors of physical and mental impairments; effect of treatment and symptom management therapies; association of clinical findings with work ability; and impact of environmental factors on work capacity. Our second objective was to describe information needed to address any data insufficiencies, if any, in these five areas.

Data Sources:

Nearly 1500 English-language articles were identified, principally from searches of MEDLINE®, CINAHL®, and Web of Science. The term multiple sclerosis was merged with concepts specific to the topic areas.

Study Selection:

Nearly 50 percent, or 739 articles, initially met the selection criteria; of these, 168 (23 percent) passed three levels of screening (titles and abstracts; full-text articles; data abstraction). Inclusion requirements included a population with MS, relevance to specific question(s) based on appropriate thresholds, and satisfactory level of evidence.

Data Extraction:

Descriptive data were partially abstracted into standardized evidence tables by a non-clinician abstractor and then completed by two clinicians (primary abstractor and over-reader). Methodological quality of each article was assessed for internal and external validity and reported in the evidence tables.

Data Synthesis:

In two recent high-quality studies, the McDonald criteria identified a high proportion of patients presenting with clinically isolated syndrome who will go on to develop clinically definite MS over 1–4 years of follow up, with a specificity of 83 to 87 percent. We found few prospective studies describing prediction of changes in physical and mental impairments over a 9- to 24-month time frame. In clinical trials, few patients improved with disease-modifying treatments and then only in the range of 1.0 point on the Extended Disability Status Scale (EDSS); rehabilitation and symptomatic treatment of spasticity, fatigue, depression, voiding dysfunction, and cognitive impairments resulted in symptom and functional status improvement. Work ability has been little studied, and few data link it to symptoms or objective physical and cognitive measures. We found no studies linking thermal sensitivity and work ability.


McDonald criteria appear to have substantial evidence for validity and inter-rater reliability in diagnosing MS; clinical data are poor at predicting 1-year clinical outcomes. Treatments do not result in improvements in impairments, but symptomatic treatments can result in improvements in functional status. Further research is required to understand the associations between clinical data and work status or work ability.


Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0025. Prepared by: Duke Evidence-based Practice Center, Durham, North Carolina.

Suggested citation:

McCrory DC, Pompeii LA, Skeen MB, Moon SD, Gray RN, Kolimaga JT, Matchar DB. Criteria to Determine Disability Related to Multiple Sclerosis. Evidence Report/Technology Assessment No. 100. (Prepared by the Duke Evidence-based Practice Center, Durham, NC, under Contract No. 290-02-0025.) AHRQ Publication No. 04-E019-2. Rockville, MD: Agency for Healthcare Research and Quality. May 2004.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.


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Bookshelf ID: NBK37333


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