Abstract
Dear Editor,
We read with attention the recent paper from Fouad et al. 1 about a new algorithmic approach for easier EDSS and functional system scores (FSS) calculation in multiple sclerosis patients.
While this article is interesting, some information in the report is inexact, and we wanted to bring some additional data.
Our team has been working on an application dedicated to EDSS calculation by healthcare professionals. This app, “Easy EDSS Score,” has been available for iOS devices since 2015. Our app has only been cited in Fouad et al.’s paper as a reference to its old and unmaintained website (www.mikeiosapps.com). Still, we wanted to add some critical information that authors may have omitted to mention.
The authors state, “Several electronic EDSS calculators were developed to overcome these problems and are available as download applications,” but “Little information is known about the basis of these methods and their agreement with the traditional paper and pencil method. Most of them provide little information about the specific rules used to estimate the FS scores and EDSS steps” and “None of these tools give a clear way to calculate the FS based on a complete neurological assessment.”
Conversely, from what has been mentioned, Easy EDSS Score allows to automatically calculate of each functional system score from the description of the neurological examination with similar algorithms as those presented in this article.
Our app has been presented for the first time as a poster at ECTRIMS 2015 in Barcelona. 2 More recently, we published a scientific research article in which we gave results regarding inter and intrarater reliability of the app. 3 Our study estimated interrater variability between a junior neurologist and an MS specialist. We showed that the electronic method reduced discrepancies for major EDSS disagreements but did not affect the global interrater agreement rate. Nevertheless, the app could avoid rating errors significantly more frequently in the junior group. Additionally, our article included all the algorithms that lead to automatic FSS determination, as the authors did in this publication.
The significant difference between the two studies is that Easy EDSS is based on the original EDSS definitions, whereas the presented algorithm is based on the Neurostatus. Indeed, our project is oriented toward daily practice, and at the moment, Neurostatus is restricted to the setting of clinical trials. A paper published by Kurtzke a few years ago underlined the importance of distinguishing those two scales, emphasizing the fact that Neurostatus should not be compared to the original scale. 4
We want to conclude by saying that we adhere to the authors’ conclusions suggesting that technology could enhance the way we define neurological disability and avoid rating tasks that are time-consuming and prone to mistakes for less experienced raters. Further research in this direction is required.
Thank you for considering our reply, as we need to bring this clarification.
Mikael Cohen and Christine Lebrun Frenay
Disclosures
Authors have nothing to disclose related to this work.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
