Published Work

SymptoMScreen: A Tool for Rapid Assessment of Symptom Severity in MS Across Multiple Domains.

2016 Apr 14

Appl Neuropsychol Adult. 2017 Mar-Apr;24(2):183-189. doi: 10.1080/23279095.2015.1125905. Epub 2016 Apr 14.

The objective of this study was to describe SymptoMScreen, an in-house developed tool for rapid assessment of MS symptom severity in routine clinical practice, and to validate SymptoMScreen against Performance Scales (PS). MS patients typically experience symptoms in many neurologic domains. A tool that would enable MS patients to efficiently relay their symptom severity across multiple domains to the healthcare providers could lead to improved symptom management. We developed "SymptoMScreen," a battery of 7-point Likert scales for 12 distinct domains commonly affected by MS: mobility, dexterity, body pain, sensation, bladder function, fatigue, vision, dizziness, cognition, depression, and anxiety. We administered SymptoMScreen and PS scales to consecutive MS patients at a specialty MS Care Center. We assessed the criterion and construct validity of SymptoMScreen by calculating Spearmen rank correlations between the SymptoMScreen composite score and PS composite score, and between SymptoMScreen subscale and the respective PS subscale scores, where applicable. A total of 410 patients with MS (age 46.6 ± 12.9 years; 74% female; mean disease duration 12.2 ± 8.7 years) completed the SymptoMScreen and PSs during their clinic visit. Composite SymptoMScreen score correlated strongly with combined PS score (r = 0.88, p < 0.0001). SymptoMScreen sub scores correlated strongly with the criterion measures of the respective PS (r = 0.69-0.87, p < 0.0001). Test-retest reliability of SymptoMScreen and its subscales was excellent (r = 0.71-0.94, p < .0001). SymptoMScreen is a single-page battery of Likert scales that assesses symptom impact in 12 domains commonly affected in MS. It has excellent criterion and construct validity. SymptoMScreen is patient and clinician friendly, takes approximately one minute to complete, and can help better document, understand, and manage patients' symptoms in routine clinical practice. SymptoMScreen is freely available to clinicians and researchers.

Which symptoms contribute the most to patients' perception of health in multiple sclerosis?

2017 Sep 5

Mult Scler J Exp Transl Clin. 2017 Sep 5;3(3):2055217317728301. doi: 10.1177/2055217317728301. eCollection 2017 Jul-Sep


Multiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosissymptoms to self-perception of health.


To investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health.


Multiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health.


Among 1865 multiple sclerosis outpatients (68% women, 78% with relapsing-remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 ('moderate to good'). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health(P < 0.001).


Pain contributed the most to multiple sclerosis outpatients' perception of health, followed by gait dysfunction and fatigue. These findings suggest that 'invisible disability' may be more important to patients' sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.


Multiple sclerosis; disability; self-rated health; self-report; symptom

Body mass index correlates with multiple sclerosis disease and symptom severity in women, but not in men

Jan 2017

Objective: To assess correlations between Body Mass Index (BMI) and Patient-derived Multiple Sclerosis Severity Score (P-MSSS), and BMI and SymptoMScreen scores in men and women with Multiple Sclerosis (MS). Background: Higher BMI during adolescence and young adulthood is a risk factor for MS, but data is conflicting concerning the relationship between BMI and disease severity in MS. Methods: BMI, Patient Determined Disease Steps (PDDS), and SymptoMScreen were recorded in consecutive clinic MS patients at the NYU MS Care Center (New York, NY) and Barnabas MS Care Center (Livingston, NJ) who were relapse-free for ≥3 months. P-MSSS was calculated based on PDDS and disease duration using a published reference table. Pearson correlation coefficients between P-MSSS and BMI, as well as between SymptoMScreen scores and BMI, were calculated independently for men and women. Separate logistic regression analyses were performed to evaluate the effect of age, sex, site of care and BMI on P-MSSS and symptom severity in 11 distinct domains. Results: 1,024 patients (74.9% women) with clinician-confirmed MS were included in the study. Men and women were similar with respect to age, BMI and disease severity scores, but men had slightly shorter disease duration than women. BMI showed a positive correlation with disease severity (P-MSSS) among women (r=0.106, p=0.0043), but not among men (r= -0.037, p=0.585). In a multiple regression model accounting for BMI, age, site of care and sex, BMI and age were the only significant predictors of disease severity (p<0.01). BMI and age were also the only significant predictors (p<0.01) of symptom severity in the domains of mobility, bodily pain, sensation, vision, depression, and anxiety. Conclusions: In this cross-sectional study, BMI showed a modest correlation with MS severity and symptom burden in women. In men, only anxiety score correlated with BMI. Further study is required to determine why BMI has a sexually dimorphic effect on disease and symptom severity

Validation of the SymptoMScreen with performance-based or clinician-assessed outcomes.

Apr 2019

Mult Scler Relat Disord. 2019 Jan 24;29:86-93. doi: 10.1016/j.msard.2019.01.031. [Epub ahead of print]

BACKGROUND: People with multiple sclerosis (MS) experience symptoms in multiple domains. High-quality patient-reported outcomes(PROs) that assess multiple domains can aid healthcare providers in assessing these symptoms and may support remote disease monitoring. The "SymptoMScreen" PRO correlates with other PROs in MS; however, whether the SymptoMScreen or its component domains are associated with performance-based or clinician-assessed outcomes is unknown.

OBJECTIVES: To validate SymptoMScreen and its domains against performance-based, clinician-assessed measures or other well-validated diagnostic tools.

METHODS: We recruited participants with MS from a large tertiary care center. At routine clinic visits participants completed the MS performance test (MSPT), which is an iPad-based application that objectively assesses walking speed, manual dexterity, processing speed, and low contrast letter acuity. Expanded Disability Status Scale (EDSS) scores were assessed in a subset. Participants also completed an online SymptoMScreen following clinic visits. We assessed criterion and construct validity by calculating Spearman rank correlations between the 12 SymptoMScreen domains and respective clinical outcomes. We evaluated test-retest reliability using intra-class correlation coefficients [ICC], and internal consistency reliability using Cronbach's alpha.

RESULTS: The 102 participants were predominantly female (78%), of average age [standard deviation]: 47.6 [12.3] years, with an average disease duration: 13.1 [10.0] years); 60 participants completed the SymptoMScreen and EDSS. Composite SymptoMScreen scores were associated with EDSS (r = 0.71; 95% CI 0.54, 0.83). For individual domains, strong correlations were observed between mobility scores and walking speed (r = 0.63; 95% CI: 0.48, 0.75) and hand function scores with manual dexterity (r = 0.52; 95% CI: 0.36, 0.65). More moderate correlations were detected for the cognition domain with processing speed (r=-0.37; 95% CI: -0.53, -0.18) and for the visual function domain with low contrast letter acuity at 2.5% contrast (r=-0.33; 95% CI -0.54, -0.08). Both test-retest and internal consistency reliability measures for overall SymptoMScreen scores were high (ICC: 0.88; 95% CI: 0.80, 0.93; Cronbach's alpha: 0.93; 95% CI: 0.90, 96).

CONCLUSIONS: The SymptoMScreen is practical outcome measure whose subscales may provide a valid assessment of corresponding performance-based and clinician-assessed measures among people with MS with mild-to-moderate disability.


Poster Presentations

Multi-dimensional assessment of symptom severity in matched NMO and MS patients


Patient-Reported SymptoMScreen Baseline Scores in Patients With Relapsing-Remitting Multiple Sclerosis Enrolled In Phase IIIb Studies of Ocrelizumab (ENSEMBLE and CASTING)


Longitudinal study of symptom botheration in Multiple Sclerosis


Tracking symptom impact in MS patients:

longitudinal study of SymptoMScreen scores in patients

attending two large tertiary MS centers


Novel Assessment of Real-World Effectiveness and Safety of Ocrelizumab for Treatment of Patients With Relapsing and Primary Progressive Multiple Sclerosis: Design of a Multicentre Non-Interventional Study (MuSicalE Study)

cmsc 2019.jpg

Construct Validity and Internal Consistency of Patient-Reported Symptomscreen in Phase IIIb Trials of Ocrelizumab in Relapsing Multiple Sclerosis (ENSEMBLE and CASTING)

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