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  2. Guy's Neurological Disability Scale

Guy's Neurological Disability Scale

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Purpose

To assess the wide range of disability in patients with multiple sclerosis.

Link to Instrument

instrument details

Area of Assessment

Gait
Pain
Spasticity
Vestibular

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis

Populations

Multiple Sclerosis

Key Descriptions

  • A comprehensive multidimensional questionnaire with 12 separate categories (4-8 questions per category) to assess the disability of patients with MS in the previous one month.
  • The questionnaire is driven by patient interview and includes a scoring section.
  • The disability subscales are:
    1) Cognition
    2) Mood
    3) Vision
    4) Speech
    5) Swallowing
    6) Upper limb function
    7) Lower limb function
    8) Bladder function
    9) Bowel function
    10) Sexual function
    11) Fatigue
    12) Others
  • Each subscale is assessed using four to eight questions, with each question to be answered yes or no. In four sections (memory, mobility, speech, mood), there are also questions asking the opinion of another person.
  • The severity of each subscale is graded from 0 (normal function) to 5 (total loss of function) based according to severity and impact on the individual.
  • The total GNDS score is the sum of the 12 separate scores ranging between 0 (no disability) and 60 (maximum possible disability).
  • The severity of each subscale is graded from 0 (normal function) to 5 (total loss of function) based according to severity and impact on the individual.
  • The total GNDS score is the sum of the 12 separate scores ranging between 0 (no disability) and 60 (maximum possible disability).

Number of Items

60

Equipment Required

  • Instructions and score sheets are found online (link not available)

Time to Administer

10-15 minutes

5 - 10 minutes, with an additional 5 minutes for scoring

Required Training

No Training

Instrument Reviewers

Initially reviewed by Susan E. Bennett, PT, DPT, EdD, NCS and the MS EDGE task force of the neurology section of the APTA in 2011.

ICF Domain

Body Structure
Body Function
Participation

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

R

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

No

Yes

No

Considerations

There may be difficulties with some patients that have severe impairment in one skill (i.e. memory and cognition or communication) and patients must be able to communicate efficiently to participate. 

The GNDS is determined to be an inadequate screen of cognitive function. 

Recommended for use with patients of EDSS 0.0-9.5, though only tested in patients ranging from 0.0-7.5. 

Recommended for awareness in entry-level curricula. 

Recommended as an appropriate tool for research purposes. The self-report covers a very wide range of areas and could be used in conjunction with other performance-based measures.

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Multiple Sclerosis

back to Populations

Minimally Clinically Important Difference (MCID)

Multiple Sclerosis:

(Sharrack and Hughes, 1999, B)

  • Level of change score for clinical significance is 3

Normative Data

Multiple Sclerosis:

(Hoogervorst et al., 2001; n = 290, participants recruited from outpatient clinic)

  •  Mean score of 14.6 (7.9) 

 

(McCrone et al., 2008; n = 1942 MS participants of the Multiple Sclerosis Society of Great Britain and Northern Ireland)

  • The mean total score of 1,942 people with MS was 21.3, with a median of 21 and a range of 5 – 51

Test/Retest Reliability

Multiple Sclerosis:

(Fraser and McGurl, 2007; n = 253, 219 were female and 32 were male—the two remaining did not indicate their sex; age range = 22-77 (9) with mean = 46; participants were all American and diagnosed with relapsing-remitting MS and a history of one or more relapses in the previous two years

  • Strong relationship (r = 0.91, p = 0.000) indicating excellent reliability 

 

(Rossier and Wade, 2002; n = 43 with patients from the community, attending a day centre or a voluntary support group; one group of 22 was assessed face-to-face multiple times over the course of two to three weeks and a second group of 21 was assessed first using a postal version of the GNDS and then face-to-face) 

  • Excellent test retest reliability of the GNDS total (r = 0.972) and each of its components (r varied from 0.685 to 0.987) 
  • Excellent test retest when administered via mail (r = 0.9)

Interrater/Intrarater Reliability

Multiple Sclerosis:

(No citation)

  • Excellent intra-rater reliability (ICC = 0.96) 

 

(Sharrack and Hughes, 1999, B)

  • Excellent inter-rater reliability (ICC = 0.99)

Internal Consistency

Multiple Sclerosis:

(No citation)

  • Excellent internal consistency in a study of 50 patients with MS (alpha = 0.87) 

 

(Fraser and McGurl, 2007)

  • Adequate internal consistency (alpha = 0.78 - 0.8)

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Fraser and McGurl, 2007) 

  • Adequate to excellent correlation for all items of the GNDS (0.30 – 0.70)
  • Adequate to excellent correlation of the Americanized GNDS with the eight subscales of the SF-36 and the ADL Self-Care for MS Scale by inverse relationship (r = 0.33-0.66) 

 

(Hoogervorst et al., 2001)

  • Excellent correlation of GNDS with EDSS scores (r = 0.73) and MSFC (r = 0.68)
  • Excellent correlation for the GNDS subcategory of lower-limb function (r = 0.79, p < 0.001) for predicting the EDSS, when using the EDSS score as the dependent variable, with an adjusted R2 of 0.80
  • Poor correlation for the GNDS subcategories of: bladder function (r = 0.22, p < 0.001), upper-limb function (r = 0.19, p < 0.001), and fatigue (r = 0.15, p < 0.001), for predicting the EDSS, when using the EDSS score as the dependent variable, with an adjusted R2 of 0.80 

 

(McCrone et al., 2008)

  • Adequate correlation between GNDS Disability Score and service costs (0.341, p < 0.001) and total costs including lost employment (0.393, p < 0.001) 

 

(Rossier and Wade, 2002)

  • Excellent validity when compared with the EDSS (r = 0.636) or the Barthel index (r = 0.757)

 

(Sharrack and Hughes, 1999, B)

  • Excellent correlations with other disability (Functional Independence Measure r = 0.81), impairment (EDSS r = 0.75; Scripps Disability Status Scale r = 0.78), and health-related quality of life scales (Physical functioning domain of the short form 36 r = 0.81) 
  • Adequate correlation with handicap scales (London Handicap Scale r = 0.52)

Responsiveness

Multiple Sclerosis:

(Sharrack and Hughes, 1999, A)

  • Moderate change of effect size of the GNDS sum score (0.58, P is less than or equal to 0.001)

Bibliography

Fraser, C. and McGurl, J. (2007). "Psychometric testing of the Americanized version of the Guy's Neurological Disability Scale." J Neurosci Nurs 39(1): 13-19. Find it on PubMed

Hoogervorst, E. L., van Winsen, L. M., et al. (2001). "Comparisons of patient self-report, neurologic examination, and functional impairment in MS." Neurology 56(7): 934-937. Find it on PubMed

McCrone, P., Heslin, M., et al. (2008). "Multiple sclerosis in the UK: service use, costs, quality of life and disability." Pharmacoeconomics 26(10): 847-860. Find it on PubMed

Rossier, P. and Wade, D. T. (2002). "The Guy's Neurological Disability Scale in patients with multiple sclerosis: a clinical evaluation of its reliability and validity." Clin Rehabil 16(1): 75-95. Find it on PubMed

Sharrack, B. and Hughes, R. A. (1999). "The Guy's Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis." Mult Scler 5(4): 223-233. Find it on PubMed

Sharrack, B. and Hughes, R. A. (1999). "Scale development and Guy's Neurological Disability Scale." J Neurol 246(3): 226. Find it on PubMed

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