Expanded Disability Status Scale (EDSS)

Evaluates disability associated with multiple sclerosis and can be used for symptom monitoring purposes.

In the text below the calculator there is more information on the scale, how the result is interpreted and the scale usage in multiple sclerosis.

The Expanded Disability Status Scale is used by neurologists in clinical settings to evaluate the degree of disability in patients with multiple sclerosis.

The scale can be performed as a one-off examination or be repeated regularly for monitoring purposes.

The EDSS was developed by John Kurtzke in 1983 as part of his neurologic research at the time.

It is administered by a neurologist or trained nurse and can last between 15 and 45 minutes, depending on how fast the tasks within are performed.

There are 20 items, each describing a different combination of symptoms that are then associated with that degree of disability severity.

4.5 - Fully ambulatory without aid; up and about much of the day; able to work a full day; may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability, usually consisting of 1 FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk approximately 300 m without aid or rest

5.0 - Ambulatory without aid or rest for approximately 200 m; disability severe enough to impair full daily activities (e.g. to work full day without special provisions; usual FS equivalents are 1 grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)

5.5 - Ambulatory without aid or rest for approximately 100 m; disability severe enough to preclude full daily activities (usual FS equivalents are 1 grade 5 alone; others 0 or 1; or combinations of lesser grades usually exceeding those for step 4.0)

6.0 - Intermittent or unilateral constant assistance (cane, crutch, or brace) required to walk approximately 100 m with or without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)

6.5 - Constant bilateral assistance (canes, crutches, or braces) required to walk approximately 20 m without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)

7.0 - Unable to walk beyond approximately 5 m even with aid; essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about approximately 12 hr/day (usual FS equivalents are combinations with more than 1 FS grade 4+; very rarely, pyramidal grade 5 alone)

7.5 - Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot carry on in standard wheelchair a full day; may require motorized wheelchair (usual FS equivalents are combinations with more than 1 FS grade 4+)

8.0 - Essentially restricted to bed or chair or perambulated in wheelchair but may be out of bed itself much of the day, retains many self-care functions; generally has effective use of arms (usual FS equivalents are combinations, generally grade 4+ in several systems)

8.5 - Essentially restricted to bed much of the day; has some effective use of arms; retains some self-care functions (usual FS equivalents are combinations, generally 4+ in several systems)

9.0 - Helpless bedridden patient; can communicate and eat (usual FS equivalents are combinations, mostly grade 4+)

9.5 - Totally helpless bedridden patient; unable to communicate effectively or eat/swallow (usual FS equivalents are combinations, almost all grade 4+)

10.0 - Death due to MS

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Expanded Disability Status Scale

The EDSS is used for both assessment and monitoring and is easily administered by a neurologist or trained nurse.

It can take between 15 and 45 minutes, depending on the length of the tasks within.

Grade	Description
0	Normal neurologic examination (all grade 0 in FS, cerebral grade 1 acceptable)
1	No disability, minimal signs in 1 FS (i.e. grade 1 excluding cerebral grade 1)
1.5	No disability, minimal signs in more than 1 FS (more than 1 grade 1 excluding cerebral grade 1)
2	Minimal disability in 1 FS (1 FS grade 2, others 0 or 1)
2.5	Minimal disability in 2 FS (2 FS grade 2, others 0 or 1)
3	Moderate disability in 1 FS (1 FS grade 3, others 0 or 1) or mild disability in 3 or 4 FS (3/4 FS grade 2, others 0 or 1) though fully ambulatory
3.5	Fully ambulatory but with moderate disability in 1 FS (1 grade 3) and 1 or 2 FS grade 2, or 2 FS grade 3, or 5 FS grade 2 (others 0 or 1)
4	Fully ambulatory without aid; self-sufficient; up and about some 12 hours a day despite relatively severe disability, consisting of 1 FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk approximately 500 m without aid or resting
4.5	Fully ambulatory without aid; up and about much of the day; able to work a full day; may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability, usually consisting of 1 FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk approximately 300 m without aid or rest
5	Ambulatory without aid or rest for approximately 200 m; disability severe enough to impair full daily activities (e.g. to work full day without special provisions; usual FS equivalents are 1 grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)
5.5	Ambulatory without aid or rest for approximately 100 m; disability severe enough to preclude full daily activities (usual FS equivalents are 1 grade 5 alone; others 0 or 1; or combinations of lesser grades usually exceeding those for step 4.0)
6	Intermittent or unilateral constant assistance (cane, crutch, or brace) required to walk approximately 100 m with or without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)
6.5	Constant bilateral assistance (canes, crutches, or braces) required to walk approximately 20 m without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)
7	Unable to walk beyond approximately 5 m even with aid; essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about approximately 12 hr/day (usual FS equivalents are combinations with more than 1 FS grade 4+; very rarely, pyramidal grade 5 alone)
7.5	Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot carry on in standard wheelchair a full day; may require motorized wheelchair (usual FS equivalents are combinations with more than 1 FS grade 4+)
8	Essentially restricted to bed or chair or perambulated in wheelchair but may be out of bed itself much of the day, retains many self-care functions; generally has effective use of arms (usual FS equivalents are combinations, generally grade 4+ in several systems)
8.5	Essentially restricted to bed much of the day; has some effective use of arms; retains some self-care functions (usual FS equivalents are combinations, generally 4+ in several systems)
9	Helpless bedridden patient; can communicate and eat (usual FS equivalents are combinations, mostly grade 4+)
9.5	Totally helpless bedridden patient; unable to communicate effectively or eat/swallow (usual FS equivalents are combinations, almost all grade 4+)
10	Death due to MS

The scale has also been used is several clinical trials for the categorization of neurological severity and for assessment of MS patients.

It has also been included in the Minimal Record of Disability by the World Health Organization.

EDSS score interpretation

There are 20 items in the scale, that are numbered from 0 to 10 with 0.5 increments. Scores closer to 0 are attributed to a normal or almost normal neurological examination while scores closer to 10 indicate a very advanced state of the disease and death.

Items from 0 to 4.5 display a minimal to mild level of disability, i.e. patients who can walk without aid. These patients are most likely to be under ambulatory treatment. These items are considered to be more subject to the clinical judgment of the neurological examiner.

The level of disability is associated with the eight functional systems (FS) in the standard neurological examination:

■ Cerebral functions;

■ Visual function;

■ Sensory;

■ Brainstem;

■ Bowel, bladder function;

■ Cerebellar;

■ Pyramidal;

■ Other.

Items from 5.0 to 9.5 indicate levels that firstly impair the walking of the patient and that of ambulation.

The middle part of the EDSS focuses on both impairment and disability.

Multiple sclerosis

MS is caused by an altered immune system response which affects the central nervous system. Basically, myelin, the coating layer of the nerves becomes increasingly damaged.

Symptoms debut around the 20s and 30s and depend on which part of the central nervous system is most affected, specifically which function the impaired nerves controlled.

Most commonly met symptoms include vision problems, fatigue, balance, dizziness and spasms.

The condition progression varies wildly depending on the initiation and effectiveness of treatment.

MS progression is highly specific and therefore, can take different degrees of severity. This is why tools like the EDSS were needed for evaluation of the disability determined by multiple sclerosis.

MS treatment currently focuses on disease modifying therapies with drugs specially created to reduce the severity of symptoms and slow down nerve destruction.

About the study

The EDSS was created by John Kurtzke in 1983, as an evaluation tool for neurological impairment that happens in MS.

It has been built based on the 8 functional systems described above and the disability status scale DSS model with the grading from 0 (normal function) to 5 or 6 (maximum impairment).

One of the limitations of the scale refers to the fact that in the administration of the scale, there is too much reliance on walking as a measure of disability. The scale should take account of a bigger variety of dysfunctionalities.

Original source

Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983; 33(11):1444-52.

Other references

1. Kurtzke JF. Disability rating scales in multiple sclerosis. Ann N Y Acad Sci. 1984; 436:347-60.

2. Noseworthy JH, Vandervoort MK, Wong CJ, Ebers GC. Interrater variability with the Expanded Disability Status Scale (EDSS) and Functional Systems (FS) in a multiple sclerosis clinical trial. The Canadian Cooperation MD Study Group. Neurology. 1990; 40(6):971-5.

Specialty: Disability

Objective: Monitoring

Type: Scale

No. Of Items: 20

Year Of Study: 1983

Abbreviation: EDSS

Article By: Denise Nedea

Published On: March 15, 2017 · 04:29 AM

Last Checked: March 15, 2017

Next Review: March 9, 2023