Abstract Details

Title In a Digital Version of the 9-Hole Peg Test, Intra-Task Speed, Accounting for Variance in Distance Traveled, May be a Better Measure of MS-Related Upper-Limb Disability Than Completion Time.

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-006

Objective To determine if speed is a better measure of MS-related decline in upper limb function than the current standard of completion time utilizing a digital version of the 9-hole peg test (MDT).

Background MDT completion time reflects both the speed and distance travelled during the task. How each contributes to the variance and whether each is related to MS disease worsening can be measured.

Design/Methods Assessments were acquired using the Multiple Sclerosis Performance Test (MSPT) within the MS PATHS network. ‘Distance’ was the summed direct distance between every consecutive peg movement. ‘Speed’ was the summed direct distance per second of completion time. Intra-patient longitudinal change associations between MDT measures and Patient-Determined Disease Steps (PDDS), Processing Speed Test (PST), and Neuro-QoL scores were assessed by repeated measure correlations. Intra-patient minimum and maximum distance and dispersion (SD/mean) for speed and completion time were calculated in patients with >2 MDT assessments. Cox-models were used to assess covariates predicting time to 20% confirmed worsening (T20%CW) in completion time after 2 years.

Results Speed and completion time showed similar significant longitudinal associations with PDDS, PST, and Neuro-QoL upper extremity scores; distance was not associated. Intra-patient distance varied substantially between assessments; 62% of patients had >10cm; 27% had >20cm differences. Speed had lower dispersion than completion time. T20%CW in completion time models had better Akaike information criterion and Bayesian information criterion values, indicating better fit, when speed was used as the predictive covariate versus completion time. Adding speed to models with completion time significantly improved model performance; adding completion time to those with speed yielded no improvement.

Conclusions MDT completion time longitudinal changes have variance contributed by fluctuating distances travelled between assessments that are unrelated to MS disease. Accounting for this variance by measuring speed lowers dispersion and improves predictive model performance for time to meaningful worsening.

Authors/Disclosures
Phoebe Jiang, PhD PRESENTER	Dr. Jiang has received personal compensation for serving as an employee of Biogen. Dr. Jiang has stock in Biogen.
Marisa P. McGinley, DO (Cleveland Clinic)	Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.
	No disclosure on file
Jay L. Alberts, PhD (Cleveland Clinic)	Dr. Alberts has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceraxis. Dr. Alberts has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceraxis. The institution of Dr. Alberts has received research support from NIH. The institution of Dr. Alberts has received research support from Department of Defense. The institution of Dr. Alberts has received research support from Michael J. Fox Foundation. Dr. Alberts has received intellectual property interests from a discovery or technology relating to health care. Dr. Alberts has received personal compensation in the range of $500-$4,999 for serving as a Member, Health and Wellness Council with Peloton Interactive.
Robert A. Bermel, MD, FAAN (Cleveland Clinic)	Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi/Genzyme. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech/Roche. Dr. Bermel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Bermel has received research support from Biogen. The institution of Dr. Bermel has received research support from Roche. The institution of Dr. Bermel has received research support from Novartis. Dr. Bermel has received intellectual property interests from a discovery or technology relating to health care.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Nicholas Levitt	Nicholas Levitt has received personal compensation for serving as an employee of Biogen Inc..
Johan Van Beek, PhD (Biogen)	Dr. Van Beek has nothing to disclose.
Nolan Campbell	Nolan Campbell has received personal compensation for serving as an employee of Biogen. Nolan Campbell has stock in Biogen.

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