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Disease Steps (DS)
Availability
Freely available from the NMSS Disease Steps (DS) website.
Classification
Supplemental: MS
Short Description of Instrument
Construct measured: Assessment of functional disability in MS primarly based on ambulation.
 
Generic vs. disease specific: Disease specific.
 
Means of administration: In person by a trained examiner, most often a neurologist. However, nurse practitioners with the proper training can also complete the neurological examination and rate the DS.
 
Intended respondent: Patient.
 
# of items: N/A.
 
# of subscales and names of sub-scales: N/A.
 
# of items per sub-scale: N/A.
Comments/Special Instructions
Scoring: Based on information gleaned from a patient's history and neurological examination, the patient is rated on an ordinal scale ranging from 0 (normal) to 6 (essentially confined to a wheelchair). There is an additional category, "U" for patients who cannot be classified into one of the 0-6 ranks.
 
Background: The Disease Steps (DS) is an ordinal clinical rating scale developed by Hohol et al (1995) to provide a straightforward assessment of functional disability in MS primarily based on ambulation. It was designed to aid in determining when to implement therapy and as a way to monitor treatment response.
Rationale/Justification
Strengths/Weaknesses: The DS is similar to the EDSS but with more consistent intervals represented by the different grades, better sensitivity, and better inter-rater reliability. One of the strengths of the DS appears to be its simplicity and since its publication, a number of modified versions have been used that allow patients to rate themselves.
 
Psychometric Properties: Inter-rater reliability is good with weighted Kappa of .80. Concurrent validity was good in the original study with a Spearman Rank Order Correlation of .96 between the DS and the EDSS. When the DS and EDSS were compared in the same patients, the DS showed a reasonably smooth distribution whereas the EDSS showed a characteristic bimodal distribution with peaks in the low and high end of the scale and a trough in the middle.
 
Administration: Administration time will vary depending upon the ability of the patient. Total administration time should be approximately 1-5 minutes. Although the DS itself can be rated in a few minutes, the medical history and neurological examination that may be needed to make the ratings can take anywhere from 15 minutes to a half-hour.