Assessing Relapse in Multiple Sclerosis (ARMS) Questionnaire: Pilot Study

Background: While many assessment tools for evaluating patients with multiple sclerosis (MS) are available to clinicians, a specific tool to evaluate patients when they present with a relapse and to assess relapse treatment effectiveness is lacking.

Objectives: The Assessing Relapse in Multiple Sclerosis (ARMS) questionnaire was developed by a panel of expert MS nurses. Part 1 consists of 7 questions designed to evaluate relapse symptoms, impact on daily activities and overall functioning, and response to past relapse treatments. Part 2 consists of 7 questions to evaluate treatment response (symptom relief, functioning, and tolerability).

Methods: A pilot study to evaluate the ARMS was conducted in 5 clinical practice sites. Eligible patients were men and women aged 18 years or older with a confirmed MS relapse. Responses to each item in Parts 1 and 2 of the ARMS questionnaire were summarized. A total composite score (TCS) was calculated based on the sum of scores from 3 inter-related questions in Part 2 regarding treatment response (symptom improvement; activities of daily living [ADL]; and return to previous state of health [RSH]); Cronbach’s a was used to estimate the internal reliability and consistency of the 3 questions and the TCS.

Results: The ARMS questionnaire has been evaluated in 103 patients (89 women, 14 men; mean [SD] age: 42.5 [11] years). The most commonly reported relapse symptoms were numbness/tingling (67%), fatigue (58%), leg/foot weakness (55%), dizziness (53%), and difficulty walking (52%). Over half of patients reported that ADL or overall functioning were affected very much (47%) or severely (11%). Prescribed treatments included corticosteroids (IV or oral; 87%) and adrenocorticotropic hormone (ACTH, 13%). Nearly half of patients reported that their symptoms were very much (33%) or completely (16%) resolved following treatment. The most commonly reported adverse events (AEs) were sleep disturbance (45%), mood changes (33%), weight gain (29%), increased appetite (26%), increased fatigue (21%), stomach upset (20%), and headache (20%). Cronbach’s [alpha] (0.87) indicated high internal reliability and consistency of the 3 interrelated questions in Part 2 and the TCS.

Conclusions: Systematic assessment of relapses and response to relapse treatment may help clinicians optimize outcomes for patients. The ARMS questionnaire may assist in promoting patient-clinician dialogue about relapses and their management across a variety of practice settings.