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Title

Kurtzke Functional System Scores (KFSS)

CDISC ReferenceClinical Classification Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

KFSS

QRS Permission StatusPublic Domain
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version2.1
StatusRevision Draft
Date2022-09-29
NotesThis supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.


Revision History

Date

Version

Summary of Changes

2022-09-29

2.1 Revision Draft

  • Added the description of the relationship between the Kurtzke Expanded Disability Status Scale (EDSS) and Kurtzke Functional Systems Scores (KFSS) instruments are intended to be used in conjunction with one another in section 3.1 Assumptions for the RS Domain Model.

2021-04-03

2.0

  • This measure was re-evaluated to fit the definition of a clinical classification measure. The domain was changed from the QS to RS domain.
  • The RSEVAL assumption and variable was removed from this supplement, since it is not captured on the CRF and no assumptions are made on the potential values.
  • The example replaced the RSBLFL variable with RSLOBXFL.
  • Updated assumption 4 on the handling of results for RSTESTCD = "KFSS108" and "KFSS108A" and updated the example accordingly.
  • Updated the example description for clarity and included the representation that at visit 2, the instrument was not conducted.

2014-02-19

1.1

Kurtzke Functional Systems Scores (KFSS) Revised

  • Added “Other Functions” category to the CRF, resulting in two additional QSTESTCDs (KFSS108 and KFSS108A).
  • Added Assumption 4 specifying how to record responses to KFSS108A.
  • Modified wording of answer choices on CRF to match wording in reference article.
  • Modified Assumptions 1 and 3 to reflect the updated CRF.
2013-11-131.0Kurtzke Functional Systems Scores (KFSS)


© 2021 Clinical Data Interchange Standards Consortium, Inc. All rights reserved.
 


1 Introduction

This document describes the CDISC implementation of the Kurtzke Functional System Scores (KFSS) instrument.

CDISC does not modify questionnaires, ratings, and scales (QRS) instruments to meet Clinical Data Acquisition Standards Harmonization (CDASH) case report form (CRF) standards.

The representation of data collected for this instrument is based on the Study Data Tabulation Model Implementation Guide (SDTMIG) Disease Response and Clin Classification (RS) domain model, which can be found on the CDISC website at: https://www.cdisc.org/standards/foundational/sdtmig.

These specific implementation details for this instrument are meant to be used in conjunction with the SDTMIG. All CDISC QRS documentation packages can be found on the CDISC website at: https://www.cdisc.org/foundational/qrs.

The CDISC Intellectual Property Policy can be found on the CDISC website at: https://www.cdisc.org/about/bylaws.

1.1 Representations and Warranties, Limitations of Liability, and Disclaimers

This document is a supplement to the SDTMIG for Human Clinical Trials and is covered under Appendix F of that document, which describes representations, warranties, limitations of liability, and disclaimers. Please see Appendix F of the SDTMIG for a complete version of this material.

CDISC specifies how to structure the data that has been collected in a database, not what should be collected or how to conduct clinical assessments or protocols. CDISC disclaims any liability for your use of this material.

2 Copyright Status

CDISC believes this instrument to be in the public domain, but you should perform your own assessment. CDISC has included the KFSS in the CDISC library of QRS data standards supplements. Hence, CDISC developed RSTESTCD and RSTEST for each item based on the actual text on the instrument. There may be many versions of this instrument in the public domain or copyrighted. CDISC has chosen to use this version as the data standard.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with example(s), and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at:https://www.cdisc.org/standards/terminology/controlled-terminology.

Reference for the KFSS:

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


3 The RS Domain Model

3.1 Assumptions for the RS Domain Model

All assumptions and business rules described in the SDTMIG RS domain are applicable to this supplement. Additional assumptions specific to the KFSS are listed below.

The KFSS consists of 7 functional systems (plus “other”) with an ordinal clinical rating scale for each functional system in either a 7-point, 6-point or 2-point scale. The functional systems included in the KFSS are the pyramidal, cerebellar, brain stem, sensory, bowel/bladder, visual, cerebral, and other functions. In addition to the functional system rating scales, there are 2 additional questions asking about weakness and temporal pallor, which could affect the ratings.

The Kurtzke Functional Systems Scores (KFSS) and Kurtzke Expanded Disability Status Scale (EDSS) instruments are intended to be used in conjunction with one another. The KFSS should first be administered by the evaluator and results from this assessment are then applied to determine an EDSS scale score (Kurtzke, 1983). A change in the EDSS should only occur if there has been a change of one or more in the Functional System (FS) scores. Please review the published Kurtzke Expanded Disability Status Scale (EDSS) for details on the related EDSS score.

  1. For each functional system of the KFSS, the scale points include a numeric rating and a definition of what is represented by the rating (e.g., 0 = “Normal”) with the exception of the “Unknown” option, which does not have a numeric rating. For the KFSS, for functional systems with a numeric rating, RSORRES is populated with the text description while the numeric rating is represented in the standardized character and numeric result variables RSSTRESC and RSSTRESN. Otherwise, RSSTRESC is populated with the rating description and RSSTRESN is left blank.
  2. Some responses to the KFSS items exceeded the 200-character limit for the RSORRES variable and needed to be reduced to fewer than 200 characters. Section 4, SDTM Mapping Strategy, indicates which item responses were revised in order to fit the 200-character limit. For item KFSS104, one of the rating responses is longer than the 200 character limit.

  3. Items KFSS102A and KFSS106A have the instruction “check here” when the subject has the specified condition (e.g., weakness, temporal pallor). RSORRES and RSSTRESC = “CHECKED” or “NOT CHECKED”. RSSTRESN is always left blank.

  4. When RSTESTCD = "KFSS108"  is not answered, the result is considered a not done record with RSORRES/RSSTRESC/RSSTRESN represented as missing values and RSSTAT = "NOT DONE”. Item RSTESTCD = "KFSS108A" will only be answered if RSTESTCD = "KFSS108" has a RSORRES = “Any other neurologic findings attributed to MS (specify)”, otherwise it will be considered a not done record with RSORRES/RSSTRESC/RSSTRESN represented as missing values and RSSTAT = "NOT DONE”.  

  5. Terminology:
    1. RSCAT, RSTESTCD, and RSTEST are approved CDISC controlled terminology.
    2. A full list of value sets for result fields is provided in Section 4: SDTM Mapping Strategy.

3.2 Example for the Kurtzke Functional System Scores (KFSS) Domain Model

The KFSS example below shows the terminology used to implement the instrument in the RS domain. This example shows the data for 1 subject collected at the baseline visit and a visit 2 represented as not being collected for the KFSS instrument. The example uses CDISC Controlled Terminology for RSTESTCD, RSTEST, and RSCAT. All original results are represented with preferred terminology in RSORRES. This result is then transformed into the standard numeric score in RSSTRESN and a character representation of the standard numeric score in RSSTRESC. Character only responses, such as "Unknown" are represented in RSORRES and RSSTRESC.

 The table represents the items from the KFSS form. The subject did not experience weakness that interfered with the testing (RSTESTCD = "KFSS102A"), but did have temporal pallor (RSTESTCD = "KFSS106A"). The subject had unknown Cerebral or Mental Functions (RSTESTCD = "KFSS107"). Since there were no other functions, RSTESTCD = "KFSS108" is represented with the response RSORRES = “None”. The record for RSTESTCD="KFSS108A" is represented with RSORRES/RSSTRESC/RSSTRESN as missing values and RSSTAT = "NOT DONE". The instrument was not done at visit 2.

rs.xpt

rs.xpt

RowSTUDYIDDOMAINUSUBJIDRSSEQRSTESTCDRSTESTRSCATRSORRESRSSTRESCRSSTRESNRSSTATRSLOBXFLVISITNUMRSDTC
1STUDYXRSP00011KFSS101KFSS1-Pyramidal FunctionsKFSSMinimal disability22
Y12012-11-16
2STUDYXRSP00012KFSS102KFSS1-Cerebellar FunctionsKFSSSevere ataxia, all limbs44
Y12012-11-16
3STUDYXRSP00013KFSS102AKFSS1-Weakness Interferes With TestingKFSSNOT CHECKEDNOT CHECKED

Y12012-11-16
4STUDYXRSP00014KFSS103KFSS1-Brain Stem FunctionsKFSSNormal00
Y12012-11-16
5STUDYXRSP00015KFSS104KFSS1-Sensory FunctionsKFSSVibration or figure-writing decrease only, in one or two limbs11
Y12012-11-16
6STUDYXRSP00016KFSS105KFSS1-Bowel and Bladder FunctionsKFSSFrequent urinary incontinence33
Y12012-11-16
7STUDYXRSP00017KFSS106KFSS1-Visual or Optic FunctionsKFSSGrade 5 plus maximal visual acuity of better eye of 20/60 or less66
Y12012-11-16
8STUDYXRSP00018KFSS106AKFSS1-Presence of Temporal PallorKFSSCHECKEDCHECKED

Y12012-11-16
9STUDYXRSP00019KFSS107KFSS1-Cerebral or Mental FunctionsKFSSUnknownUnknown

Y12012-11-16
10STUDYXRSP000110KFSS108KFSS1-Other FunctionsKFSSNone00
Y12012-11-16
11STUDYXRSP000111KFSS108AKFSS1-Other Functions SpecifyKFSS


NOT DONEY12012-11-16
12STUDYXRSP000112KFSS101KFSS1-Pyramidal FunctionsKFSS


NOT DONE
22012-12-16
13STUDYXRSP000113KFSS102KFSS1-Cerebellar FunctionsKFSS


NOT DONE
22012-12-16
14STUDYXRSP000114KFSS102AKFSS1-Weakness Interferes With TestingKFSS


NOT DONE
22012-12-16
15STUDYXRSP000115KFSS103KFSS1-Brain Stem FunctionsKFSS


NOT DONE
22012-12-16
16STUDYXRSP000116KFSS104KFSS1-Sensory FunctionsKFSS


NOT DONE
22012-12-16
17STUDYXRSP000117KFSS105KFSS1-Bowel and Bladder FunctionsKFSS


NOT DONE
22012-12-16
18STUDYXRSP000118KFSS106KFSS1-Visual or Optic FunctionsKFSS


NOT DONE
22012-12-16
19STUDYXRSP000119KFSS106AKFSS1-Presence of Temporal PallorKFSS


NOT DONE
22012-12-16
20STUDYXRSP000120KFSS107KFSS1-Cerebral or Mental FunctionsKFSS


NOT DONE
22012-12-16
21STUDYXRSP000121KFSS108KFSS1-Other FunctionsKFSS


NOT DONE
22012-12-16
22STUDYXRSP000122KFSS108AKFSS1-Other Functions SpecifyKFSS


NOT DONE
22012-12-16
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4 SDTM Mapping Strategy

This section is used for reference regarding the CRF data capture and to understand the alignment of the instrument to the SDTM RS domain. It also provides guidance on how the result variables (RSORRES, RSSTRESC, and RSSTRESN) should be populated.

RSTESTCD = "KFSS101" RSTEST = "KFSS1-Pyramidal Functions "

RSORRES

RSSTRESC

RSSTRESN

Normal00
Abnormal signs without disability11
Minimal disability22
Mild or moderate paraparesis or hemiparesis; severe monoparesis33
Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia44
Paraplegia, hemiplegia, or marked quadriparesis55
Quadriplegia66
UnknownUnknown


RSTESTCD = "KFSS102" RSTEST = "KFSS1-Cerebellar Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Abnormal signs without disability11
Mild ataxia22
Moderate truncal or limb ataxia33
Severe ataxia, all limbs44
Unable to perform coordinated movements due to ataxia55
UnknownUnknown


RSTESTCD = "KFSS102A" RSTEST = "KFSS1-Weakness Interferes With Testing"

RSTESTCD = "KFSS106A" RSTEST = "KFSS1-Presence of Temporal Pallor"

RSORRES

RSSTRESC

CHECKEDCHECKED
NOT CHECKEDNOT CHECKED


RSTESTCD = "KFSS103" RSTEST = "KFSS1-Brain Stem Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Signs only11
Moderate nystagmus or other mild disability22
Severe nystagmus, marked extraocular weakness, or moderate disability of other cranial nerves33
Marked dysarthria or other marked disability44
Inability to swallow or speak55
UnknownUnknown


RSTESTCD = "KFSS104" RSTEST = "KFSS1-Sensory Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Vibration or figure-writing decrease only, in one or two limbs11
Mild decrease in touch or pain or position sense, and/or moderate decrease in vibration in one or two limbs; or vibratory (c/s figure writing) decrease alone in three or four limbs22
Moderate decrease in touch or pain or position sense, and/or lost vibration in 1 or 2 limbs; or mild decrease in touch or pain and/or moderate decrease in all proprioceptive tests in 3 or 4 limbs33
Marked decrease in touch or pain or loss of proprioception, alone or combined, in one or two limbs; or moderate decrease in touch or pain and/or severe proprioceptive decrease in more than two limbs44
Loss (essentially) of sensation in one or two limbs; or moderate decrease in touch or pain and/or loss of proprioception for most of the body below the head55
Sensation essentially lost below the head66
UnknownUnknown


RSTESTCD = "KFSS105" RSTEST = "KFSS1-Bowel and Bladder Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Mild urinary hesitancy, urgency, or retention11
Moderate hesitancy, urgency, retention of bowel or bladder, or rare urinary incontinence22
Frequent urinary incontinence33
In need of almost constant catheterization44
Loss of bladder function55
Loss of bowel and bladder function66
UnknownUnknown


RSTESTCD = "KFSS106" RSTEST = "KFSS1-Visual or Optic Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Scotoma with visual acuity (corrected) better than 20/3011
Worse eye with scotoma with maximal visual acuity (corrected) of 20/30 to 20/5922
Worse eye with large scotoma, or moderate decrease in fields, but with maximal visual acuity (corrected) of 20/60 to 20/9933
Worse eye with marked decrease of fields and maximal visual acuity (corrected) of 20/100 to 20/200; grade 3 plus maximal acuity of better eye of 20/60 or less44
Worse eye with maximal visual acuity (corrected) less than 20/200; grade 4 plus maximal acuity of better eye of 20/60 or less55
Grade 5 plus maximal visual acuity of better eye of 20/60 or less66
UnknownUnknown


RSTESTCD = "KFSS107" RSTEST = "KFSS1-Cerebral or Mental Functions"

RSORRES

RSSTRESC

RSSTRESN

Normal00
Mood alteration only (does not affect DSS score)11
Mild decrease in mentation22
Moderate decrease in mentation33
Marked decrease in mentation (chronic brain syndrome – moderate)44
Dementia or chronic brain syndrome – severe or incompetent55
UnknownUnknown


RSTESTCD = "KFSS108" RSTEST = "KFSS1-Other Functions"

RSORRES

RSSTRESC

RSSTRESN

None00
Any other neurologic findings attributed to MS (specify)11
UnknownUnknown


Original and RSORRES Comparison - RSTESTCD=KFSS104

RSSTRESN

KFSS1-Sensory Functions (Original)

RSORRES Value

0

Normal

Normal

1

Vibration or figure-writing decrease only, in one or two limbs

Vibration or figure-writing decrease only, in one or two limbs

2

Mild decrease in touch or pain or position sense, and/or moderate decrease in vibration in one or two limbs; or vibratory (c/s figure writing) decrease alone in three or four limbs

Mild decrease in touch or pain or position sense, and/or moderate decrease in vibration in one or two limbs; or vibratory (c/s figure writing) decrease alone in three or four limbs

3

Moderate decrease in touch or pain or position sense, and/or essentially lost vibration in one or two limbs; or mild decrease in touch or pain and/or moderate decrease in all proprioceptive tests in three or four limbs

Moderate decrease in touch or pain or position sense, and/or lost vibration in 1 or 2 limbs; or mild decrease in touch or pain and/or moderate decrease in all proprioceptive tests in 3 or 4 limbs

4

Marked decrease in touch or pain or loss of proprioception, alone or combined, in one or two limbs; or moderate decrease in touch or pain and/or severe proprioceptive decrease in more than two limbs

Marked decrease in touch or pain or loss of proprioception, alone or combined, in one or two limbs; or moderate decrease in touch or pain and/or severe proprioceptive decrease in more than two limbs

5

Loss (essentially) of sensation in one or two limbs; or moderate decrease in touch or pain and/or loss of proprioception for most of the body below the head

Loss (essentially) of sensation in one or two limbs; or moderate decrease in touch or pain and/or loss of proprioception for most of the body below the head

6

Sensation essentially lost below the head

Sensation essentially lost below the head


Unknown

Unknown



End of Document

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