Background: The Brief International Cognitive Assessment for MS (BICAMS) and Multiple Sclerosis Outcomes Assessment Consortium (MSOAC) battery are frequently used to monitor cognitive and motor function in people with MS (PwMS). While previous studies established benchmarks of clinically meaningful change on these tests, the real-world anchors were based on deterioration in function. Little is known about meaningful testing benchmarks based on gains in function, an increasingly relevant anchor considering improvements that may arise with higher efficacy disease modifying medication.
Objective: We aimed to investigate ‘work status gains’ in PwMS, and compare BICAMS and MSOAC test scores of those with said gains to patients reporting work stability or decline.
Methods: A retrospective analysis was performed on a longitudinal database of 783 PwMS. All subjects were monitored with an online tool called the Buffalo Vocational Monitoring Survey. This analysis included 208 patients with a follow-up timepoint coincident with BICAMS and MSOAC tests.
Results: At follow-up, 36.1% of PwMS reported at least one type of work status gain, such as a reduction in negative work events (25.5%) or an actual improvement in work status, such as from part-time to full-time (6.7%), among others. 8.2% reported a decrease in work status (e.g., full-time to unemployed) and 43.3% reported being work stable without any positive work gains. ANCOVA models comparing those with and without work status gains showed significant differences between the groups in longitudinal change on the Symbol Digit Modalities Test (SDMT), F(1)=3.92, p=0.049. Among the work status improved group, subjects showed an average increase (or clinically meaningful improvement) of 4.87 points on the SDMT.
Conclusions: Benchmarks for clinically meaningful improvement on the SDMT mirror those previously established for clinically meaningful decline. The importance of such benchmarks is reaffirmed, particularly that of score increases, and is especially relevant in considering the efficacy of certain interventions for maintaining and/or improving employment outcomes.