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RehabMeasures Instrument

Rehabilitation Measure

Disease Steps

Last Updated


Disease Steps assesses functional disability in MS patients.

Link to Instrument

Instrument Details

Area of Assessment


Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil




  • Multiple Sclerosis

Key Descriptions

  • Disease Steps serves as a guide for neurologists in the decision of when to intervene therapeutically and also to observe the patient’s response over time. Classification is based on ambulation status as well as a history of neurologic examination.
  • The ambulation scale, walking 25 feet, consists of:
    0 = Functionally normal with no limitations on activity or lifestyle
    1 = Mild disability, mild symptoms or signs
    2 = Moderate disability, visible abnormality of gait
    3 = Early cane, use of a cane or other form of unilateral support for greater distances, but can walk at least 25 feet without it
    4 = Late cane, cane dependent, unable to walk 25 feet without a cane or other form of unilateral support
    5 = Bilateral support, requires bilateral support to walk 25 feet
    6 = Confined to wheelchair
    U = Unclassifiable, used for patients who do not fit above classification
  • The neurological exam performed requires client participation that establishes scores 1-2.

Number of Items


Equipment Required

  • 25-foot unobstructed walkway
  • Score sheets found at

Time to Administer

15-35 minutes

Required Training

No Training

Instrument Reviewers

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

Body Part

Lower Extremity

ICF Domain

Body Structure
Body Function

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:




Highly Recommend




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


Not Recommended


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


Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility



Home Health








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







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)







Disease Steps is heavily weighted towards ambulation. Unclassifiable patients include individuals with severe visual impairment, overwhelming fatigue, significant bowel or bladder involvement, or severe cognitive impairment in patients with otherwise minor physical disability. 

Disease Steps may be more sensitive for patients who use unilateral support. 

May not capture acute attacks and does not incorporate measures of disease activity such as attack frequency. 

May not be for a skilled nursing facility as a majority of patients there would be a 6 on the scale. 

Scale is specific to MS and strongly correlates with the EDSS gold standard. 

Recommended for EDSS 0.0-9.5. 

Recommended for entry-level curricula. 

Not recommended for research purposes; possible limited objectivity with the scale. More objective scales include Timed 25’ Walk, 2- or 6-minute Walk, or 5 Times Sit to Stand.

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Multiple Sclerosis

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Normative Data

Multiple Sclerosis:

(Hohol et al., 1999) 

  • Median staying time at a specific level was 12 months

Interrater/Intrarater Reliability

Multiple Sclerosis:

(Hohol et al., 1999) 

  • Median staying time at a specific level was 12 months

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Hohol et al., 1995) 

  • Excellent correlation between Disease Steps and the EDSS (Spearman’s coefficient = 0.958) 

(Hohol et al., 1999) 

  • Excellent correlation between Disease Steps scores and EDSS (r = 0.944) 
  • Excellent correlation between change in Disease Steps scores and change in EDSS: at 2 years (r = 0.635) and at 3 years (r = 0.622) 
  • Adequate correlation between change in Disease Steps scores and change in EDSS at 1 year ( r = 0.545)


Hohol, M. J., Orav, E. J., et al. (1995). "Disease steps in multiple sclerosis: a simple approach to evaluate disease progression." Neurology 45(2): 251-255. Find it on PubMed 

Hohol, M. J., Orav, E. J., et al. (1999). "Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression." Mult Scler 5(5): 349-354. Find it on PubMed

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