Contributions
Abstract: P316
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Instrumental activities of daily living (IADLs) assess the ability of a person to perform tasks necessary for independent living. Accumulation of disability in MS impacts a person"s ability to perform IADLs. Impaired IADLs may predict future disability progression.
Objective: To evaluate the utility of IADLs to discriminate between disability levels and to determine whether IADLs can be used to predict future changes in disability.
Methods: The NARCOMS Registry Fall 2006 update survey asked participants to complete the Lawton IADL survey which measures whether assistance is needed to perform 8 tasks, such as grocery shopping, doing housework, and handling finances. Scores range from 8 to 24 with 24 indicating that no help is needed for any task. The Patient Determined Disease Steps (PDDS) is measure of disability which is highly correlated with the EDSS and is asked in each semi-annual NARCOMS update survey. Longitudinal PDDS data from up to 18 subsequent update surveys through the Spring 2015 were identified for the Fall 2006 respondents to model the trajectory of disability change over time. Cross-sectional analyses and longitudinal analyses used linear and repeated measures regression methods respectively.
Results: Of the respondents to the Fall 2006 survey, 9661 had data for the IADLs and PDDS questions. These participants had a median (25%, 75%) of 13 (6, 17) follow-up surveys. 11.8% (n=1138) of them had 17 surveys while 20.8% (n=2007) had all 18. 76.3% (n=7374) were female, 92.6% (n=8612) Caucasian, the mean (SD) age in 2006 was 52 (10.5). Over two-thirds of the participants reported a vascular or mental comorbidity. Median (25%, 75%) PDDS was 4 (1, 6) [Early Cane (Mild Disability, Bilateral Support)] and mean (SD) disease duration 14 years (9.4). Mean (SD) IADL score was 20.5 (3.7) and the proportion needing no help on any tasks dropped markedly between PDDS level 1 and 3 (0, 84.2%; 1, 60.7%; 2, 26.9%; 3, 29%). In univariate analyses as disability level increased, the IADL score decreased (r=-0.726, p< 0.0001) and the relationship persisted after controlling for age (p=0.63), sex (p< 0.0001) and current health status (p< 0.0001). The adjusted longitudinal model showed that lower IADL scores were independently associated with greater trajectories of disability change.
Conclusion: Even mild disability is associated with impairment in activities associated with independent living, and impaired IADLs predict future disability progression.
Disclosure:
Dr. Salter has nothing to disclose.
Dr. Fox has received consultant fees from Biogen Idec, GlaxoSmithKline, Novartis, Questcor, Teva, and Xenoport; grant and research support from Novartis.
Dr. Tyry has nothing to disclose.
Dr. Cutter: Data and Safety MonitoringBoards: Apotek, Biogen-Idec, Cleveland Clinic (Vivus), Glaxo Smith Klein Pharmaceuticals, GileadPharmaceuticals, Horizen Pharmaceuticals, Modigenetech/Prolor, Merck/Ono Pharmaceuticals, Merck,Merck/Pfizer, Neuren, Sanofi-Aventis, Teva, Washington University, NHLBI (Protocol ReviewCommittee), NINDS, NICHD (OPRU oversight committee); Consulting or Advisory Boards: Consortium ofMS Centers (grant), D3 (Drug Discovery and Development), Genentech, Genzyme, JannsenPharmaceuticals, Klein-Buendel Incorporated, Medimmune, Novartis, Opexa Therapeutics, Receptos,Roche, EMD Serono, Teva pharmaceuticals, TGTherapeutics Inc., Transparency Life Sciences.
Dr. Marrie has conducted clinical trials for Sanofi Aventis, has received research funding from CIHR, MS Society of Canada, National MS Society, CMSC, MS Scientific Research Foundation, Research Manitoba.
Abstract: P316
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Instrumental activities of daily living (IADLs) assess the ability of a person to perform tasks necessary for independent living. Accumulation of disability in MS impacts a person"s ability to perform IADLs. Impaired IADLs may predict future disability progression.
Objective: To evaluate the utility of IADLs to discriminate between disability levels and to determine whether IADLs can be used to predict future changes in disability.
Methods: The NARCOMS Registry Fall 2006 update survey asked participants to complete the Lawton IADL survey which measures whether assistance is needed to perform 8 tasks, such as grocery shopping, doing housework, and handling finances. Scores range from 8 to 24 with 24 indicating that no help is needed for any task. The Patient Determined Disease Steps (PDDS) is measure of disability which is highly correlated with the EDSS and is asked in each semi-annual NARCOMS update survey. Longitudinal PDDS data from up to 18 subsequent update surveys through the Spring 2015 were identified for the Fall 2006 respondents to model the trajectory of disability change over time. Cross-sectional analyses and longitudinal analyses used linear and repeated measures regression methods respectively.
Results: Of the respondents to the Fall 2006 survey, 9661 had data for the IADLs and PDDS questions. These participants had a median (25%, 75%) of 13 (6, 17) follow-up surveys. 11.8% (n=1138) of them had 17 surveys while 20.8% (n=2007) had all 18. 76.3% (n=7374) were female, 92.6% (n=8612) Caucasian, the mean (SD) age in 2006 was 52 (10.5). Over two-thirds of the participants reported a vascular or mental comorbidity. Median (25%, 75%) PDDS was 4 (1, 6) [Early Cane (Mild Disability, Bilateral Support)] and mean (SD) disease duration 14 years (9.4). Mean (SD) IADL score was 20.5 (3.7) and the proportion needing no help on any tasks dropped markedly between PDDS level 1 and 3 (0, 84.2%; 1, 60.7%; 2, 26.9%; 3, 29%). In univariate analyses as disability level increased, the IADL score decreased (r=-0.726, p< 0.0001) and the relationship persisted after controlling for age (p=0.63), sex (p< 0.0001) and current health status (p< 0.0001). The adjusted longitudinal model showed that lower IADL scores were independently associated with greater trajectories of disability change.
Conclusion: Even mild disability is associated with impairment in activities associated with independent living, and impaired IADLs predict future disability progression.
Disclosure:
Dr. Salter has nothing to disclose.
Dr. Fox has received consultant fees from Biogen Idec, GlaxoSmithKline, Novartis, Questcor, Teva, and Xenoport; grant and research support from Novartis.
Dr. Tyry has nothing to disclose.
Dr. Cutter: Data and Safety MonitoringBoards: Apotek, Biogen-Idec, Cleveland Clinic (Vivus), Glaxo Smith Klein Pharmaceuticals, GileadPharmaceuticals, Horizen Pharmaceuticals, Modigenetech/Prolor, Merck/Ono Pharmaceuticals, Merck,Merck/Pfizer, Neuren, Sanofi-Aventis, Teva, Washington University, NHLBI (Protocol ReviewCommittee), NINDS, NICHD (OPRU oversight committee); Consulting or Advisory Boards: Consortium ofMS Centers (grant), D3 (Drug Discovery and Development), Genentech, Genzyme, JannsenPharmaceuticals, Klein-Buendel Incorporated, Medimmune, Novartis, Opexa Therapeutics, Receptos,Roche, EMD Serono, Teva pharmaceuticals, TGTherapeutics Inc., Transparency Life Sciences.
Dr. Marrie has conducted clinical trials for Sanofi Aventis, has received research funding from CIHR, MS Society of Canada, National MS Society, CMSC, MS Scientific Research Foundation, Research Manitoba.