Introduction

The Social Security Administration (SSA)

operates the world’s largest and most stringent

disability program, processing more than 3.5

million claims each year, with multiple sclerosis

(MS) representing the third most common

neurological diagnosis cited as the cause for

disability.

1 The purpose of this project, nominated

by SSA and contracted through the Agency for

Healthcare Research and Quality (AHRQ), is to

determine whether current medical knowledge

supports the SSA’s stated policies regarding MS.

In January 2003, the Duke Evidence-based

Practice Center began work on this 13-month

task to review evidence from the medical

literature for use in updating SSA’s listing of

impairments for multiple sclerosis (MS) and for

revising its disability policy (if indicated).

Research Questions

The seven major research questions addressed

during this review are as follows:

Question 1a: What is the reliability of new

McDonald criteria (incorporating supplementary

information from radiologic and laboratory studies

including magnetic resonance imaging [MRI],

visual evoked potential [VEP], and cerebrospinal

fluid [CSF] analyses) compared with long-term

follow-up diagnosis of clinically definite MS

according to the Poser criteria? 

Question 1b: What is the inter-rater reliability of

diagnosis of MS according to Poser or McDonald

criteria among neurologists or between neurologists

and non-neurologist physicians?

Question 2: What clinical indicators, including

particularly time-course of impairments, predict

physical or mental impairment at 12 months? 

Question 3a: Among patients with MS, do

current disease-modifying treatments result in longterm improvements in physical or mental outcomes

compared to placebo or usual care?

Question 3b: Among patients with MS, do

treatments aimed at symptom management result in

improvements in physical or mental outcomes

compared to usual care? 

Question 4: Among individuals with MS, what

physical, mental, laboratory, or radiographic findings

have been associated with inability to work? 

Question 5: Among individuals with MS, how

does elevated temperature or other environmental

factors impair the capacity to work? 

Key Terms and Definitions

Knowledge of the terms used in the SSA

disability evaluation process, components of that

process, and Medical Listing criteria related to

MS is critical to the reader’s understanding of this

report. To assist in the preparation of the report,

SSA provided explanations of terms and processes

as currently defined by SSA regulations and

rulings. The terms cited below, as well as other

terms and processes used by SSA for disability

determination, are defined and described in the

SSA publication, Disability Evaluation Under

Social Security 2003.

2

The statutory definition of “Disability” is “the

inability to engage in any substantial gainful

activity by reason of a medically determinable

physical or mental impairment(s) which can be

expected to result in death or which has lasted or

can be expected to last for a continuous period of

not less than 12 months.” This definition differs

from the clinically used definition of the World

Health Organization’s International Classification

of Impairments, Disabilities and Handicaps,

3 which

defines disability as “any restriction or lack of

Evidence Report/Technology Assessment

Number 100

Criteria to Determine Disability Related to 

Multiple Sclerosis

Summary

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service

Agency for Healthcare Research and Quality
2

ability to perform an activity in a manner or within the range

considered normal for a human being.” While much of the

medical literature uses the latter, broader definition, the reader

must be aware that the goals of this report relate to the

statutory definition.

The following terms are defined by current (2003) SSA

regulations:

• “Claimant” is anyone who has filed a disability claim.

• “Substantial Gainful Activity” is the ability to earn an

average of $800 per month.

• “Medically Determinable Impairment” is a physical or

mental impairment that results from anatomical,

physiological, or psychological abnormalities which can be

shown by medically acceptable clinical and laboratory

diagnostic techniques.

• “Evidentiary Requirements” for disability determination are

described by SSA regulation. An acceptable medical source

must report signs, symptoms, and laboratory findings

diagnostic of an impairment. Although a claimant’s

reported signs and symptoms are not sufficient to meet the

evidentiary requirements for establishing the presence of a

medically determinable impairment, all available evidence

including the claimant’s report of symptoms is used to

evaluate the impact of any documented impairment(s) on

the claimant’s ability to carry out work tasks. 

• “Severe Impairment” is defined by the agency as any

“impairment that more than minimally limits the

claimant’s ability to do basic work activities.”

The regulations include a Listing of Impairments for each

body system that define disability. Often referred to as the

“medical listings,” this list allows quick disability

determinations to be made on the basis of medical criteria

alone. The SSA publication, Disability Evaluation Under Social

Security 2003,

2 under the neurological category of

impairments, includes Listing 11.09.

11.09 Multiple Sclerosis with:

A. Disorganization of motor function as described in 11.04; or

B. Visual or mental impairment as described under the criteria

in 2.02, 2.03, 2.04, or 12.02: or

C. Significant, reproducible fatigue of motor function with

substantial muscle weakness on repetitive activity,

demonstrated on physical examination, resulting from

neurological dysfunction in areas of the central nervous system

known to be pathologically involved by the multiple sclerosis

process.

Full details on the Medical Listing for multiple sclerosis,

including the imbedded references to sections 2, 11, and 12,

are available in the above-cited SSA publication.2

“Residual Functional Capacity” is assessed when a claimant

is determined to have a “severe” impairment that does not meet

or equal the intent of the medical listings. Physical capacity

(lifting, carrying, walking, standing, sitting, pedaling, and so

on) and mental capacity (cognitive and behavioral, thought

processing, concentration, pace, behavior) are assessed in

determining residual functional capacity.

To adjudicate claims by individuals with MS for disability

benefits, SSA must determine whether the claims file includes

information from an acceptable medical source that documents

the signs, symptoms, and laboratory findings that are diagnostic

of a physical or mental impairment. SSA adjudicators also

determine whether the impairment would be expected to more

than minimally interfere with the claimant’s capacity to carry

out basic work activities for at least 12 consecutive months or

end in death. If a severe impairment is identified, the

adjudicator determines whether the medical findings meet or

equal an impairment in the medical listings. If the

documented impairment does not meet or equal a listed

impairment, the adjudicator must determine the claimant’s

residual functional capacity and consider vocational factors

prior to making a final disability determination. 

Methods

A systematic and comprehensive search of the medical

literature was conducted and was followed by a thorough

review and evaluation of the literature determined to be

relevant to the major research questions.

Literature Sources

The primary sources of literature were MEDLINE® (1966-

April 2003), CINAHL® (1983-April 2003), Cochrane

Database of Systematic Reviews, and Web of Science. Searches

of these databases were supplemented by reviews of reference

lists contained in all included articles and in relevant review

articles and meta-analyses.

Search Strategies

Searches were limited to the English language and to human

subjects. For efficacy-of-treatment topics, the searches were also

limited to studies with randomized controlled trial designs. In

all, there were five major searches: 

1. Search 1 was a general search targeting MS and

employment issues that merged search terms for multiple

sclerosis, transverse myelitis, and optic neuritis with

employment terms such as disability evaluation, work

capacity evaluation, employment, and activities of daily living.

No study designs were excluded.

2. Search 2 was targeted to studies on the reliability of

diagnostic criteria for MS. Major search terms employed

were multiple sclerosis (exploded), multiple sclerosis/di

(limited to diagnostic articles), text word options for poser

and mcdonald, and exploded terms reproducibility of results/
or observer variation/ or psychometrics, along with the text

word reliability. No study designs were excluded.

3. Search 3 focused on treatment of fatigue for MS and

specified several drugs used in the treatment of MS-related

fatigue. No study designs were excluded.

4. Search 4 looked for a wide range of symptomatic therapies

(other than fatigue) and disease-modifying therapies. A

wide selection of treatments was specified, and the search

was limited to randomized controlled trial designs.

5. Search 5 was focused on the predictive value of the

McDonald diagnostic criteria, specifically on their use of

additional paraclinical diagnostic methods (MRI, VEP, and

CSF) and on studies reporting sensitivity, specificity, and

reproducibility.

All searches, including narrowly focused sub-searches,

yielded 1,487 potentially relevant citations.

Abstract and Full-text Screening Criteria

For each question, we developed fairly detailed instructions

and decision rules for the screeners’ reference. There were very

broad inclusion requirements for abstracts: MS study subjects

and potential relevance to any of the five questions. For the

full-text screening, screeners were asked to record their

include/exclude decision, research question assignment, and, if

appropriate, exclusion criteria that detailed insufficiencies in

study design and clinical substance requirements.

The titles and abstracts of the 1,487 articles were reviewed

against the inclusion/exclusion criteria by at least two of five

clinical investigators. The full text of each article passing the

title-and-abstract screening was retrieved from the library for

further review.

At the full-text review stage, each article was independently

evaluated by two investigators, who forwarded their decisions

to the task order manager for recording and comparison. If

indicated, reviewers were asked to reconcile differences of

opinion and return a reconciled final decision. If reviewers had

difficulty reaching agreement, or submitted indecisive codes,

the principal investigator was the arbiter.

Approximately 50 percent of the articles were included after

the abstract screening and full-text article review stages.

Data Abstraction and Development of

Evidence Tables

Data from articles included after full-text screening were

abstracted directly into an evidence table template, which

served as a data abstraction form. The study’s writer/editor

began the process with a partial abstraction of each included

article. The partial abstraction included descriptions of the

study design, interventions, number of subjects at the start of

the study, and types of outcomes data to be collected. The

partial abstraction form was forwarded to a clinician for

completion and then returned to the writer/editor, who

checked it for completeness and consistency of information and

forwarded it to a second clinician for over-reading. The overreader returned the table to the writer/editor for a final check of

the completeness of the content, editing, and formatting. 

At the end of the data abstraction stage and the very close

scrutiny of each article, 168 articles were included. 

Results and Discussion

The primary goal of this review was to examine the evidence

in the medical literature for data that can guide policy in

determining disability in MS patients. Although the literature

in general (and certain studies in particular) suffers from

limitations, reasonably strong conclusions can still be drawn for

most of the seven research questions.

Reliability of Criteria for Diagnosing MS

This topic encompassed two questions: 

Question 1a: What is the reliability of new McDonald criteria

(incorporating supplementary information from radiologic and

laboratory studies including MRI, VEP, and CSF analyses)

compared with long-term follow-up diagnosis of clinically definite

MS according to the Poser criteria? 

Question 1b: What is the inter-rater reliability of diagnosis of

MS according to Poser or McDonald criteria among neurologists or

between neurologists and non-neurologist physicians.

Analytic approach. Regarding Question 1a, the most

important difference between the Poser criteria4 and the new

McDonald criteria5 is the addition of MRI findings to the

diagnosis of MS, in lieu of the presence of a second attack.

Our approach to this question was to identify studies in two

categories: (1) those that specifically compared the new

McDonald criteria to long-term diagnosis of clinically definite

MS according to the Poser criteria; and (2) those that provided

data on the accuracy of various MRI techniques, VEP analyses,

and CSF analyses as supplements to clinical diagnosis of MS.

For Question 1b, the relevant diagnostic criteria were the

Poser and McDonald criteria plus any other clinical, laboratory,

neurological exam, MRI, VEP, CSF, or other data supporting

the MS diagnosis. Results had to describe data on agreement

or disagreement on the MS diagnosis between evaluating

physicians. Agreement statistics could include kappa scores,

sensitivity and specificity rates, or other data of the type that

could be used to complete a two-by-two table.

Results. The validity of the McDonald criteria is wellsupported by two types of evidence: (1) follow-up studies of

patients with clinically isolated syndrome (CIS) diagnosed

according to the McDonald criteria and (2) studies that

correlate specific MRI findings (components of the McDonald

criteria) with clinical diagnosis. First, two studies6,7 show that

between 73 and 94 percent of patients presenting with CIS

who go on to develop clinically definite MS over 1 to 4 years of

follow up could be diagnosed with MS according to the

McDonald criteria (but would have been undiagnosed under

3
4

previous Poser criteria). Furthermore, the specificity of the

McDonald criteria is reasonably high, ranging from 83 to 87

percent. Second, many studies8-16 support the MRI component

of the McDonald criteria by showing a strong and consistent

association between the number of T2 lesions on MRI and the

subsequent development of clinically definite MS among

patients with CIS or optic neuritis.

Two studies17,18 examined the inter-rater reliability of

neurologist-physicians in diagnosing MS according to the Poser

criteria; one of these18 also examined inter-rater reliability in

diagnosing MS according to the McDonald criteria. We found

no data examining inter-rater reliability among non-neurologist

clinicians. Overall, there was substantial agreement between

observers in classifying MS. Poorer agreement was observed in

determining whether a patient had one or more “attacks” of

MS and in interpretation of MRI. 

Discussion. From the studies identified in the review, the

McDonald criteria appear to have substantial evidence for

validity and offer the obvious potential advantage of resulting

in an earlier diagnosis of MS than the Poser criteria permit.

The McDonald criteria have been criticized for their

complexity in comparison with previous criteria; however, we

found data that demonstrate that these criteria yield a good

overall diagnostic reliability, at least as good as the previous

Poser criteria. However, data about reliability are available only

for neurologists specializing in MS; adoption of the new criteria

by clinicians with less expertise could result in deterioration of

reliability. Further research on the inter-rater reliability of these

criteria in broader clinical settings would be helpful to

determine the quality of MS diagnosis.

Prediction of Physical or Mental Impairment

at 12 Months

The research question for this topic was What clinical

indicators, including particularly time-course of impairments,

predict physical or mental impairment at 12 months?

Analytic approach. There were four main categories of

clinical predictors of particular interest to the analysis: (1)

clinical characteristics such as exacerbation rates, disease type,

age at disease onset, sex, degree of remission after relapse, and

type and number of neurological symptoms; (2) imaging

studies, particularly MRI; (3) laboratory test results such as

apolipoprotein E (APOE) «4 allele and intrathecal

immunoglobulin-G (IgM) synthesis; and (4) self-reported

health status using validated scales.

Our evaluation was limited to those studies with a time

course of 12 months (SSA’s statutory limit), a timeframe which

treating physicians would not ordinarily consider an important

decision point. The course of MS has typically been studied

over time horizons of many years. 

Results. We found relatively little data describing changes in

neurological or other impairments over 9 to 24 months;

however, we used the data that were available to approximate

the 12-month time horizon dictated by statutory requirements.

Clinical characteristics have been the best studied, with four

reports providing evidence for this review.19-22 Brain23,24 and

spinal cord25 MRI have not been shown to be promising.

Suggestive evidence is available for laboratory markers26-29 and

self-reported quality of life,30 but these indicators will need

further study to establish their reliability and utility. While

clinical features do not individually provide reliable guidance

on prognosis, multivariate predictive models based on relatively

easy-to-obtain features may have better performance; such

models have not, however, been validated. 

Discussion. The ability to predict the future course of MS

has been an active area of research; however, most studies

examining disease course do so over relatively long time periods

(5 to 20 years). The limited predictive ability of some

multivariate models has not been validated in populations other

than those in which the models were developed; thus, their

value for predicting disability has yet to be determined.

Disease-modifying Therapies and Long-term

Improvement

Research Question 1a was targeted to current diseasemodifying therapies: Among patients with MS, do current

disease-modifying treatments result in long-term improvements in

physical or mental outcomes compared to placebo or usual care?

Analytic approach. Interventions of interest were all

current (2003) disease-modifying immunomodulatory and

immunosuppressive treatments. Outcomes of interest were

absolute improvements that might result in an individual who

is unable to work becoming able to work. The following

domains were considered: physical functioning (primarily

Expanded Disability Status Score [EDSS]), relapse frequency,

cognitive functioning, quality of life, and adverse events.

Results. Most of the data suggest that few patients improve

on disease-modifying therapy. Those few who do improve

generally do so only in the range of 1.0 point on the EDSS.

We found no data regarding improvement in work ability and

no data that would correlate a 1.0-point improvement in EDSS

with improvement in work ability. The significance of a 1.0-

point EDSS improvement varies depending on baseline EDSS

score (because the scale is non-linear), but the improvement

data available are not generally stratified according to baseline

EDSS score. With regard to work ability, the significance of

the available data on clinical improvement is unclear. We

found no data that quantified individual patient improvement

with regard to cognitive function or quality-of-life measures.

Discussion. Our review does not support a conclusion that

the current therapies are likely to result in substantial

improvement in a significant proportion of patients with MS.

This finding is consistent with expert opinion and

demonstrated by the design inherent in current clinical trials,

that is, the use of lack of decline in EDSS scores as the primary
outcome measure. Current therapies are generally regarded as

allowing for a modest reduction in progression of MS –

particularly in the relapsing-remitting patient population – but

are not generally expected to result in significant long-term

improvement. Recently, however, combination therapies have

begun to be used in the treatment of MS; such combinations of

current therapies or new therapies may have greater potential to

result in improvements in neurological status.

Symptom Management and Improvement 

Symptom management was the focus of Question 3b:

Among patients with MS, do treatments aimed at symptom

management result in improvements in physical or mental

outcomes compared to usual care.

Analytic approach. The effectiveness of symptomatic

therapies for spasticity, rehabilitation, urinary management,

fatigue, depression, and cognitive impairment was examined.

Relevant outcomes were analyzed within six categories: (1)

symptom-specific functional status or quality-of-life outcomes;

(2) physical functioning (primarily EDSS); (3) cognitive

functioning; (4) work or employment outcomes; (5) generic

quality-of-life outcomes; and (6) adverse events.

Results and discussion. Treatment aimed at alleviation of

symptomatic manifestations of MS, rather than at the

underlying disease, could have an important role in maximizing

functioning among people with MS. Among the six areas we

investigated, the degree of impairments and the effectiveness of

the treatments varied. We found:

• Although drugs such as baclofen, diazepam, dantrolene and

tizanidine are often used to reduce spasticity in MS, the

research evidence for a beneficial therapeutic effect is

inconsistent. Uncertain findings here, as with other

symptoms (cognitive impairment, fatigue), may be due, in

part, to measurement issues. Better measurement tools

may be required in order to confirm the clinical impression

that widely used anti-spasticity drugs such as baclofen,

tizanidine, and dantrolene are more effective than placebo.

Given current measurement techniques, it is not surprising

that active-treatment comparison studies fail to show

clinically important differences among these drugs.

• Physiotherapy interventions failed to influence impairments as

measured by EDSS. These interventions were, however,

associated with measurable changes in functional status.

Improvements in health (handicap) were observed in the

Medical Outcomes Study 36-Item Short-Form Health

Survey (SF-36) and several other measures. The

interventions employed in rehabilitation studies were

multifaceted, and it is difficult to attribute beneficial effects

to particular components of the interventions. 

• Depression treatments, including psychotherapy, behavioral

therapy, and certain drug therapies, can lead to measurable

improvements in mood, but the link to improved functional

status and, further, to ability to work was not demonstrated in

these studies per se. There are few data linking treatment of

depression to improvements in other symptoms (such as

fatigue or cognitive impairments) or other outcomes (such

as functional status or quality of life). 

• Measurement of fatigue is limited by a definition that spans

several domains, leading to difficulty with validation.

Amantadine appears to have some ability to alleviate

fatigue in MS, as demonstrated by statistically significant

differences in some outcomes in several trials;31-34 however,

the clinical significance of these effects is likely small.

Pemoline has been less often studied and shows results

suggesting some effect.33-35 There is little support for the

efficacy of 4-aminopyridine.36 Modafinil has shown

promising results in phase-II trials,37 but has not yet been

evaluated in a double-blind randomized controlled trial.

Further research on new pharmacological therapies (such as

modafinil) and development of additional data on the

validity of instruments for fatigue measurement and their

sensitivity to change would be helpful directions for future

research. 

• Studies of treatments for voiding dysfunction show clear

improvements in symptoms, but provide less clear data on how

improvements in urinary symptoms impact other areas of

health, and no data on how these symptomatic improvements

impact work ability. Desmopressin was highly effective at

reducing urine volume and also consistently effective at

reducing urinary frequency.38-42 This was shown to translate

into improvements in uninterrupted sleep hours and in

fewer episodes of incontinence. Physical treatments,

including both pelvic floor rehabilitation43 and use of a

handheld vibrator during micturition,44 were also shown to

reduce urinary symptoms compared with control. Many

interventions commonly used for urinary disorders in MS

have not been studied in randomized controlled trials of

MS patients. Commonly used interventions for which no

randomized controlled trials have been performed among

MS patients include anticholinergic and antimuscarinic

drugs, behavior modification, and intermittent or

indwelling urinary catheterization.

• None of the studied treatments for cognitive impairments has

had a consistent measurable effect on cognitive performance in

MS. Treatment of cognitive impairments has been little

studied and indirectly studied, in the sense that most data

on cognitive effects are inferred from studies aimed at

treatment of fatigue or depression. One study suggested

that fatigue symptoms do not correlate with cognitive

impairment, though they do correlate with symptoms of

depression.34 Future studies would benefit from more

precise delineation of study population based on screening

for cognitive performance deficits within a relatively

narrow and defined range; this would likely improve the

chances of finding a treatment effect and would also make

5
6

clearer the population for whom the results would be

applicable.

Association of Clinical Findings and Work

Ability

In contrast to the previous questions, Question 4 directly

linked clinical results with ability to work: Among individuals

with MS, what physical, mental, laboratory, or radiographic

findings have been associated with inability to work?

Analytic approach. The phrasing of this question

predetermined the outcome of interest as ability to work.

Findings reported as absolute and relative measures of physical

and mental/cognitive function and laboratory and radiographic

testing related to work activity were assessed. 

Results and discussion. There is a significant gap between

what is included in the literature and the type of research

evidence required to link objective clinical measures (physical,

mental, laboratory, and radiographic findings) with ability to

work. Although objective physical and cognitive measures have

been developed, their application in the occupational literature

is sparse. Furthermore, assessment of how symptoms such as

pain and fatigue impact work ability is essentially absent. The

reported findings on work ability displayed some consistency

across studies. For example, individuals who had higher EDSS

levels45,46 or low cognitive function47 were more likely to report

not working. However, the strength of association across these

studies was not clearly demonstrated, as most reported

frequencies or crude estimates of association. Several studies

had small sample sizes, which hindered researchers from

calculating risk estimates that were adjusted for potential biases

such as age, education, level of employer assistance, job type,

and desire to work. In addition, most studies considered only

physical function or cognitive function, when both can hinder

employment. 

Environmental Factors and Work Ability 

Similar to the previous question, the focus of Question 5 was

the ability to work: Among individuals with MS, how does

elevated temperature or other environmental factors impair the

capacity to work?

Analytic approach. The evidence sought for this question

was on the association of workplace environmental conditions

and demands (ambient temperature, individual’s body

temperature, heat or cold exposure) on the ability of an

individual with MS to work. Relative and absolute measures of

association were assessed.

Results. With regard to work impairment, limitation, or

disability related to temperature conditions, we found

remarkably little research that met our inclusion criteria; thus,

this question remains mostly unanswered. The one included

report confirmed that some MS patients perceive that excessive

heat impedes their work capacity.

48

Discussion. The evidence provides no basis for

generalizations such as maximum appropriate working

temperature levels unique to MS patient populations. It is

unlikely that medical data in Social Security Disability

Insurance (SSDI) application files in the current era will

include objective diagnostic test results identifying MS patients

who respond adversely to heat challenges. However, subjective

patient reports may describe such associations with or without

clinician comment or correlation with objective clinical status

measures. Although not necessarily founded on randomized

controlled trial data, current clinical impression seems to hold

that ambient and/or exercise-induced body temperature effects

may bear a relationship to MS symptom status in some

patients, perhaps more so than is thought to be the case for

chronic disease states in general.

Future Research

Future research about work ability among individuals with

MS can shed a great deal of light on factors that foster or

hinder employment. Our full report,49 particularly the evidence

reported on association of clinical findings and work ability,

highlights significant evidence and information gaps

concerning 

• Patterns of MS patient reports regarding functional

limitations. 

• Information commonly collected in medical encounters

with MS patients (and therefore available to SSA). 

• Knowledge about the impact on performance of specific

work tasks of commonly objectified parameters such as

coordination, strength, and vision, and especially of factors

such as fatigue or cognitive dysfunction, which are either

difficult to measure or are less commonly assessed in detail.

• Effective research methods for categorizing job or task

demands in such a way as to isolate those demands that are

likely to be “critical” for an SSDI applicant with MS.

In the context of these gaps, it may be productive to pursue

research approaches that simultaneously address four domains: 

1. Subjective reports (this domain is not sufficient alone for

SSDI determination purposes).

2. Objective clinical data (ideally of the sort commonly

encountered in medical records).

3. In-depth objective measures (which may be available and

not widely applied clinically. but which may be used with

subsets of subjects to explore correlation with other

domains).

4. Work status measures (ideally longitudinal, with

stratifications based on work demands).

Such an approach may apply to thermal sensitivity as well,

with some additional specification and focus. Parallel

assessment of concomitant ambient temperature, physical
exertion, and core body temperature would address key relevant

physiological exposure factors. 

Outcome measures could include the domains outlined

above, for example: 

• Self-perceived well-being and level of symptoms such as

fatigue. 

• Clinical parameters such as walking speed or muscle

strength.

• In-depth measures such as potentially associated

biomarkers or physiological parameters.

• Work status measures, including absenteeism and disability

benefits use.

Availability of the Full Report

The full evidence report from which this summary was taken

was prepared for the Agency for Healthcare Research and

Quality (AHRQ) by the Duke Evidence-based Practice Center,

under Contract No. 290-02-0025. It is expected to be available

in May 2004. At that time, printed copies may be obtained free

of charge from the AHRQ Publications Clearinghouse by

calling 800-358-9295. Requesters should ask for Evidence

Report/Technology Assessment No. 100, Criteria to Determine

Disability Related to Multiple Sclerosis. In addition, Internet

users will be able to access the report and this summary online

through AHRQ’s Web site at www.ahrq.gov.

Suggested Citation

McCrory DC, Pompeii LA, Skeen MB, Moon SD, Gray

RN, Kolimaga JT, Matchar DB. Criteria to Determine

Disability Related to Multiple Sclerosis. Summary, Evidence

Report/Technology Assessment No. 100. (Prepared by the

Duke Evidence-based Practice Center, under Contract No.

290-02-0025.) AHRQ Publication No. 04-E019-1. Rockville,

MD: Agency for Healthcare Research and Quality. May 2004.

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www.ahrq.gov

AHRQ Pub. No. 04-E019-1

May 2004

ISSN 1530-440X