Relationship of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) to functional, emotional, and neuropsychological outcomes.

OBJECTIVE: To explore the relationship of the Multiple Sclerosis Neuropsychology Questionnaire (MSNQ; [Benedict, R. H. B., Cox, D., Thompson, L. L., Foley, F., Weinstock-Guttman, B., & Munschauer, F. (2004). Reliable screening for neuropsychological impairment in multiple sclerosis. Multiple Sclerosis, 10, 675-678; Benedict, R. H. B., Munschauer, F., Linn, R., Miller, C., Murphy, E., Foley, F., et al. (2003). Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire. Multiple Sclerosis, 9, 95-101]), a self-report screening measure of neuropsychological functioning in multiple sclerosis (MS), with everyday life functioning, neuropsychological functioning, and mood in MS. Additionally, to investigate the validity, sensitivity, and specificity of the MSNQ to predict cognitive impairment in persons with MS. STUDY DESIGN: Cross-sectional, correlational analyses; analyses of sensitivity and specificity. SETTING: Neuropsychology lab-based study with adults from the community including persons with MS (n=48) and healthy adults (n=40). MAIN OUTCOME MEASURES: Subjective and objective measures of everyday life functioning, neuropsychological functioning, and mood; ROC curve of MSNQ-Self report and MSNQ-Informant report, sensitivity and specificity of MSNQ-S and MSNQ-I. RESULTS: Correlational analyses indicate the MSNQ-S is significantly correlated with mood and self-reports of functioning, but not with objectively measures daily functioning and to only few neuropsychological tests. The MSNQ-I was not significantly correlated to mood, self-report of daily functioning or objectively measured daily functioning, but was significantly correlated with several measures of neuropsychological functioning. CONCLUSION: The MSNQ-S was not supported as a sensitive screen for neuropsychological impairment in MS. However, the MSNQ-I was supported as a valid and sensitive screen of cognitive impairment in persons with MS, although further research is needed to determine an optimal cutoff score for this measure.

The structure of functional and community outcomes following traumatic brain injury.

OBJECTIVES: To investigate the dimensionality of functional and community outcomes following serious TBI. To identify items that fit, misfit or are redundant, as well as to assess person misfit. METHODS: Rating-scale (Rasch) analysis was applied to 1-year follow-up data from 231 cases in the US National TBI Model Systems database. Items selected for analysis included all items indicative of global outcomes, disability, activity or participation. RESULTS: A powerful singular measurement dimension was identified. Item reliability was very high (0.98), as was person reliability (0.97). The dimension fit over 90% of cases; that is approximately 10% of cases displayed anomalous patterns of functioning that indicated that their functioning was not measurable in terms of the general dimension identified. There was tension within the dimension between ratings of dependency (FIM) and cognitive functioning in everyday life (NFI). Most-but not all-neuropsychological test scores misfit the outcome dimension. CONCLUSIONS: Actual dimensionality was distinct from the named scales employed. A unidimensional measure model fit the data much better than expected. This outcome dimension might be called 'general community functioning'. In the future, it should be possible to develop more valid and parsimonious measures of community outcomes following TBI.

The relation between subjective and objective measures of everyday life activities in persons with multiple sclerosis.

OBJECTIVES: To investigate the relation between subjective and objective performance-based measures of functional status in persons with multiple sclerosis (MS), and to compare their performance with healthy controls. DESIGN: A between-groups design, using a correlational approach to examine the relation between objective and subjective measures of functional capacity. SETTING: Outpatient rehabilitation research institution. PARTICIPANTS: Seventy-four subjects with clinically definite MS and 35 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Executive Function Performance Test (EFPT), Functional Assessment of Multiple Sclerosis (FAMS), and Functional Behavior Profile (FBP). RESULTS: MS participants reported more difficulties performing functional tasks than did the healthy controls. MS participants also performed significantly worse on the EFPT than healthy controls. However, all correlations between subjective and objective functional measures were nonsignificant. After controlling for depressive symptomatology, EFPT performance was significantly associated with FBP scores, but not FAMS scores. CONCLUSIONS: The lack of association between objective performance-based measures and subjective self-report measures of functional activities is a challenge to outcomes measurement and has implications for assessment of functional performance. Results are discussed in terms of the different dimensions that these tools are measuring and their respective strengths and limitations.

Scaling of the revised Oswestry low back pain questionnaire.

OBJECTIVE: To evaluate the measurement properties of the Revised Oswestry Disability Questionnaire (RODQ) by using rating scale analyses. DESIGN: Calibration of item responses by using a data set. SETTING: Four outpatient therapy clinics in the northeastern United States. PATIENTS: Convenience sample of 95 community-dwelling adults exhibiting mild to severe low back pain-related disability (LBP-D). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The RODQ. RESULTS: Several Rasch analyses were performed, with 1 item deleted and 2 response categories collapsed, creating a better test without increased error. A schema for item administration and evaluation was also developed. CONCLUSIONS: By using the abbreviated scale, suggested item order, and predicted responses, abbreviated versions of the instrument can be applied to measure LBP-D more efficiently.

Assessing functional status: exploring the relationship between the multiple sclerosis functional composite and driving.

OBJECTIVE: To explore the relationship between the Multiple Sclerosis Functional Composite (MSFC), which is comprised of 3 clinical dimensions (arm and hand function, leg function and ambulation, cognition), and an everyday functional skill, driving performance. DESIGN: Cohort study. SETTING: Medical rehabilitation research organization. PARTICIPANTS: Twenty-nine individuals with documented multiple sclerosis (MS) and limited motor decrements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving-related skills were measured by using the overall category rating from the Useful Field of View (UFOV) Test, its 3 subtests, the error and latency scores from the Neurocognitive Driving Test (NDT), subjective (self-report) and objective (Department of Motor Vehicles [DMV] reports) reported driving experience, and number of motor vehicle crashes. Within the group, differences were explored between participants rated as low risk versus moderate-high risk on the UFOV overall score and between participants who reported a change in driving habits after MS versus those who reported no change. RESULTS: The overall MSFC score correlated significantly with the UFOV overall score, the visual-information processing and selective attention subtests of the UFOV, the NDT latency score, as well as with the number of days a week the individual drove and the number of crashes reported by the DMV. An examination of the MSFC components revealed that the cognition component was significantly related to the UFOV overall score, all 3 subtests of the UFOV, and the NDT latency score. The arm and hand function component correlated significantly with NDT latency and the selective attention subtest of the UFOV. Individuals classified as low risk on the UFOV overall had more education, better MSFC scores, and lower NDT latency scores. Only the overall MSFC score distinguished those who reported a change in driving habits after onset of MS. CONCLUSIONS: Problems with everyday functional skills such as driving are accurately identified through the use of the overall MSFC and its components.