Consensus Conference: Comprehensive Management of Complex Symptoms in MS

Background: There is a growing body of knowledge on the prevalence and impact of symptoms and impairments caused by multiple sclerosis (MS). However, little is known about how symptoms and impairments, along with comorbidities, contribute to activity and participation limitations. A consensus conference was convened in Sept., 2012 to examine best practices about mobility and complex symptoms of MS with a focus on cognition, motor control, comorbidities (osteoporosis, bladder function) and subjective symptoms (pain, fatigue).

Objectives: The focus of the conference was on how complex symptoms and mobility impact each other.   Participants were asked to review evidence-based current practice to identify knowledge gaps about management of complex symptoms in MS, and to propose strategies to assess and manage problems in the context of mobility limitations.

Methods: Twenty-five experts from varied disciplines in MS care and clinical research were invited. Prior to meeting, a literature review was conducted and 25 evidence-based articles about MS and complex symptoms were disseminated to the panel. The conference opened with presentations on four complex symptom areas and how they impact mobility.  During the afternoon, the panel focused on evidence specific to complex symptom and mobility; current practice related to managing the symptom; and evidence-based consensus statements about best practices.

Results: We will present one aspect of the panel discussions, specifically assessment tools for mobility and various symptoms. Using the International Classification of Functioning, Disability and Health (ICF) framework, we will propose a model describing interaction between selected complex symptoms and mobility, taking into account body function and structures, activities, participation, environmental and personal factors. Relevant measurement tools (questionnaires, scales, clinical tests) will be described in relation to the model, along with a brief description of their characteristics.

Conclusions: The proposed framework and related measures will serve as a basis to identify opportunities for future research and clinical care enhancement, and to help with development of clinical and research protocols.

Conference Participants: Theodore  Brown, Jack Burks, Peggy Crawford, Marcia Finlayson, Frederick Foley, John Foley, Donna Fry, Elsie Gulick, Colleen Harris, Rock Heyman, David Jones, Rosalind Kalb, Herbert Karpatkin, Virgil Mathiowetz, Marie Namey, Amy Perrin Ross, Matthew Plow, Stephen Rao, Cindy Richman, Alan Segaloff, Matthew Sutliff, Paul Tobin, Bianca Weinstock-Guttman. Funding for the consensus conference was provided by Acorda Therapeutics, Inc.