Category Archives: Functional Testing

Multiple Sclerosis Functional Composite (MSFC)

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Multiple Sclerosis Functional Composite (MSFC)

The MSFC is a three-part, standardized, quantitative, assessment instrument for use in clinical studies, particularly clinical trials, of MS. (Cutter et al, 1999) It was developed by a special Task Force on Clinical Outcomes Assessment that had been appointed by the National Multiple Sclerosis Society’s Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. (Whitaker et al, 1995; Rudick et al, 1996) It was the consensus of the task force that important clinical dimensions not emphasized in existing rating scales, e.g. cognition, should be measured. The MSFC was designed to fulfill three criteria:

  1. It should be multidimensional to reflect the varied clinical expression of MS across patients and over time
  2. The dimensions should change relatively independently over time
  3. One component should be a measure of cognitive function. The three components of the MSFC measure leg function/ambulation, arm/hand function, and cognitive function.

Administration Time

Administration time will vary depending upon the ability of the patient. Total administration time for all three measures should be approximately 20-30 minutes.

Administration Method

The MSFC measures are administered in person by a trained examiner. The examiner need not be a physician or nurse.

Scoring

The MSFC can produce scores for each of the three individual measures as well as a composite score. In addition, there are a variety of ways to calculate scores depending on the nature of the study and sample.

General Comments

The three component measures of the MSFC had been used for some time in MS prior to their being combined into a composite measure. Analysis of data from studies using these measures had pointed to their reliability, validity, and sensitivity. As a set of objective, quantitative assessment instruments, the MSFC represents a methodological advance over the ordinal clinical rating scales that have been used in MS in the past, e.g., the EDSS and Ambulation Index. A three-part instrument offering both separate and composite scores, the MSFC provides a versatile assessment method for investigational purposes with the ability to measure patients at various levels of disability, i.e., ambulation at less disabled levels of the EDSS, arm function at more disabled levels, and cognitive function at all levels. Since its introduction, the MSFC has seen increasing use in both clinical trials and other clinical studies.

Psychometric Properties

All three measures making up the MSFC have been shown to have good inter-rater and test-retest reliability. In addition, there is considerable evidence for their validity and sensitivity to clinically relevant change in MS patients. However, performance on the MSFC is sensitive to practice effects, that is, patients often display poorer performance when first tested due to lack of familiarity with the tasks. It is recommended that three or four administrations be given prior to a baseline assessment if accurate (rather than comparative) assessments of change over time are needed. Refer to the discussion of the individual components of the MSFC for further details concerning their psychometric properties.

http://www.nationalmssociety.org/for-professionals/researchers/clinical-study-measures/msfc/index.aspx

Modified Physical Performance Test

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Modified Physical Performance Test

Testing Protocol: Administer the test as outlined below. Subjects are given up to two chances to complete each item. Assistive devices are permitted for tasks 6 – 9.

1. Standing Static Balance
• Feet together: “Stand still with your feet together as demonstrated for 10 seconds.”
• Semi Tandem: “Stand with the heel of one foot placed to the side of the 1st toe of the opposite foot for 10 seconds.” Subject chooses which foot goes forward.
• Tandem: “Stand with the heel of one foot directly in front of the other foot, for 10 seconds. Subject chooses which foot goes forward.

2. Chair Rise: Use a straight back chair with a solid seat that is 16” high. Ask participant to sit on the chair with arms folded across their chest. “Stand up and sit down as quickly as possible 5 times, keeping your arms folded across your chest.” Stop timing when the participant stands the 5th time.

3. Book Lift: Place a Physician’s Desk Reference Book (1988 PDR: 5.5 lbs) or other heavy book on a table in front of the patient. Ask the patient, when given the command “go” to place the book, as quickly as they can, on a shelf above shoulder level. Time from the command “go” until when the book is resting on the shelf. Starting position is with their hands at their side.

4. Put on and remove a jacket: If the subject has a jacket or cardigan sweater, ask them to remove it. If not, give the subject a lab coat. Ask the subject, on the command “go” to quickly put the coat on completely such that it is straight on their shoulders and then remove the garment completely. Time from the command “go” until the garment has been completely removed. Hint: it is more accurate to time putting on the garment, then pause (pause the stopwatch), then time taking off the garment.

5. Pick up a penny from floor: Place a penny approximately 12 inches from the patient’s foot on the dominant side. Ask the patient, on the command “go” to pick up the penny from the floor and stand up. This is to be done as quickly as they can; yet allowing for safety and comfort. Time from the command “go” until the subject is standing erect with a penny in hand. If dexterity is a problem, a pen or similar lightweight object can be used

6. Turn 360 degrees: Ask the subject to turn 360 degrees “as quickly as you can, as you feel comfortable and safe”. Evaluate using the scale on PPT scoring sheet. Additional data: count the number of steps required.

7. 50-foot walk test: Bring subject to start on a 50 foot walk test course (25 feet out and 25 feet back) and ask the subject, on the command “go” to walk as quickly as they can to the 25-foot mark and back. Time from the command “go” until the starting line is crossed on the way back.

8. Stairs: Take vital signs. Bring subject to foot of stairs (nine to 12 steps) and ask subject, on the command ”go” to begin climbing up to a total of 4 flights stairs (as quickly as they can, as they feel comfortable and safe) or until they feel tired and wish to stop. Before beginning this task, alert the subject to the possibility of developing chest pain or shortness of breath and inform the subject to tell you if any of these symptoms occur. You will walk with the subject. Time from the command “go” until the subjects’ first foot reaches the top of the first flight of stairs. Go on to record the number of flights (maximum is four) completed (up and down is one flight). Provide a chair for resting when completed, so vital signs can be taken immediately post.

Scoring: 32/36 – 36/36 = not frail
25/36 – 31/36 = mild frailty 17/36 – 24/36 = moderate frailty
< 17/36 = unlikely to be able to function in the community

Brown, M., Sinacore, D.R. (2005). Physical and Performance Measures for the identification of mild to moderate frailty.  J Gerontol A Biol Sci Med Sci 55:M350-5

Modified Physical Performance Test Instructions
Modified Physical Performance Test Score Sheet

Dynamic Gait Index

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Dynamic Gait Index Score Sheet
(Adapted from Shumway-Cook & Woollacott Motor Control: Theory and Practical Applications, 1995)

 
1. Gait level surface _____
Instructions: Walk at your normal speed from here to the next mark (20’)
Grading: Mark the lowest category that applies.
(3) Normal: Walks 20’, no assistive devices, good speed, no evidence for imbalance, normal gait pattern.
(2) Mild Impairment: Walks 20’, uses assistive devices, slower speed, mild gait deviations.
(1) Moderate Impairment: Walks 20’, slow speed, abnormal gait pattern, evidence for imbalance.
(0) Severe Impairment: Cannot walk 20’ without assistance, severe gait deviations or imbalance.

 
2. Change in gait speed _____
Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for 5’). When I tell you “slow,” walk as slowly as you can (for 5’).
Grading: Mark the lowest category that applies.
(3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds
between normal, fast and slow speeds.
(2) Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or no gait deviations but is unable to achieve a significant
change in velocity, or uses an assistive device.
(1) Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, or
changes speed but loses significant gait deviations, or changes speed but loses balance but is able to recover and continue walking.
(0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.

 
3. Gait with horizontal head turns _____
Instructions: Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight, but return your head to the center.
Grading: Mark the lowest category that applies.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers, outside 15” path, loses balance, stops, reaches for wall.

 
4. Gait with vertical head turns _____
Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down. Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the center.
Grading: Mark the lowest category that applies.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs task with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs task with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers, outside 15” path, loses balance, stops, reaches for wall.

 
5. Gait and pivot turn _____
Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to face the opposite direction and stop.
Grading: Mark the lowest category that applies.
(3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.
(2) Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance.
(1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn & stop.
(0) Severe Impairment: Cannot turn safely, requires assistance to turn and stop.

 
6. Step over obstacle ____
Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking.
Grading: Mark the lowest category that applies.
(3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.
(2) Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box safely.
(1) Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal cueing.
(0) Severe Impairment: Cannot perform without assistance.

 
7. Step around obstacles _____
Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the right side of it. When you come to the
second cone (6’ past first cone), walk around it to the left.
Grading: Mark the lowest category that applies.
(3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance.
(2) Mild Impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones.
(1) Moderate Impairment: Is able to clear cones but must significantly slow speed to accomplish task, or requires verbal cueing.
(0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance.

 
8. Steps _____
Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.
Grading: Mark the lowest category that applies.
(3) Normal: Alternating feet, no rail.
(2) Mild Impairment: Alternating feet, must use rail.
(1) Moderate Impairment: Two feet to a stair, must use rail.
(0) Severe Impairment: Cannot do safely.

 
TOTAL SCORE: ___ / 24

 
Scoring Information:
21/24 or above = minimal to no risk for falls
Below 21 indicates risk for falls and the lower the score the more the risk
Common score for moderate stage Parkinson Disease = 9-11/24.