We used our customized EMR toolkits built to capture standardized data at office visits for quality improvement and practice based research in treating patients with demyelinating disorders. We also developed clinical decision support tools and best practice advisories within the toolkits to alert physicians when a quality improvement opportunity exists. 348 patients were included in this analysis with the following nonproprietary clinical measures used: estimated EDSS (E-EDSS); Cognitive (STMS); fatigue (FSS); and depression (CESD). Based on brain MRI lesion load of T1 (BT1L) and T2 (BT2L), patients were divided in groups: 0 lesions; 1-10; 11-20 and above 20/confluent. Spine MRI T2 lesion load groups were present versus absent.

There was a significant correlation between BT2L and all clinical measures studied (vs. E-EDSS p=0.007, vs. STMS p= 0.004, vs. FSS p=0.041), except CESD (p=243). BT1L significantly correlated with E-EDSS (p=0.03), and trended with STMS (p=0.068), but did not correlate with FSS (p=0.853) and CESD (p=0.699). The presence of spinal cord lesion correlated with E-EDSS (p=0.012), but there was no correlation with BT2L or BT1L and spinal cord lesion, suggesting they are independent risk factors for physical disability.

Although the correlation between spinal cord lesion and physical disability is expected, the strong correlations between physical and cognitive disabilities and BT2L is somewhat surprising and does not support the prevailing view of independence of these measures in the management of MS. The lack of correlation with BT1L might be related to a relatively small sample size.