Episode Overview

Podcast: The MSing Link
Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Episode 268: How to Track MS Symptoms at Home: 2 Self-Assessment Questionnaires
Date: January 21, 2026

In this episode, Dr. Gretchen Hawley discusses how people with Multiple Sclerosis (MS) can meaningfully track whether their symptom-management strategies—like exercise, nutrition, or other interventions—are actually making a difference in daily life. She focuses on two gold-standard, research-validated subjective self-assessment questionnaires that can be completed at home, offering clear guidance on implementation and interpretation. Dr. Hawley emphasizes the importance of trends over time, and how these tools can empower individuals to better communicate with their care teams.

Key Discussion Points and Insights

1. The Problem with Traditional Strength Testing

• Manual muscle testing (MMT) can be discouraging and subjective.
  • Dr. Hawley recounts a patient story: despite months of feeling stronger and walking better, her patient’s neurologist’s manual muscle test suggested worsening strength.
  • This left the patient “so bummed and discouraged and was feeling like, oh my gosh, my exercises aren’t working…I just replied with one question of, okay, but how do you feel?” [03:00]
• MMT’s Limitations:
  • Highly subjective; influenced by the tester and the day.
  • “There’s no number…It could just depend on the day, regardless of who's doing it.” [03:26]
• Feeling Matters Most:
  • Dr. Hawley underscores that improvements should also be judged by personal experience, not just single, subjective test results.

2. Understanding Subjective vs. Objective Outcome Measures

• Subjective Tests: Surveys/Questionnaires based on your own perception of how symptoms impact daily life.
• Objective Tests: Measure physical metrics directly (timed walks, repetitions, etc.).
  • “Objective…give us a number…But those tests often can’t measure your confidence…fatigue impact on your daily life…or quality of life.” [06:34]
• This episode’s focus: Gold-standard subjective self-assessments for MS.

3. Introducing Two Gold-Standard MS Questionnaires

A. Modified Fatigue Impact Scale (MFIS)

Purpose: Measures the impact of fatigue on daily life across three domains: physical, cognitive, and psychosocial. Details:

• 21 questions covering the past four weeks.
  • Domains: physical functioning (“Is your fatigue impacting your walking?”), cognitive functioning, psychosocial functioning (“Are you isolating yourself more because of your fatigue?”)
• Scoring: Each question rated 0 (no problem) to 4 (extreme problem).
• What scores mean: “There's no specific cutoff for good or bad…What matters is your change over time.” [13:40]
• Example Questions:
  • “In the last four weeks, I have been less alert.”
  • “I’ve had difficulty making decisions.”
  • “I have been less motivated to do anything requiring physical effort.” [11:25]
• Best Practices:
  • Complete every 4–8 weeks, tracking changes rather than isolated results.
  • For consistency, try to take it under similar circumstances each time (same time of day, similar type of day).

B. Multiple Sclerosis Walking Scale 12 (MSWS-12)

Purpose: Measures the impact of MS on walking ability—including quality, confidence, and endurance—over the past two weeks. Details:

• 12 questions scored 1 (not at all limited) to 5 (completely limited).
• Topics include:
  • “How much has your Ms. Limited your ability to walk, run, climb up/down stairs, stand while doing tasks, or maintain balance?” [21:12]
• Scoring:
  • Total score ranges from 12 to 60. Higher scores indicate greater walking limitation.
  • “A four point change is clinically meaningful…Any positive trend is worth celebrating, even if it’s just one point.” [24:47]
• Best Practices:
  • Also recommended to track every 4–8 weeks, even though the scale refers to the last two weeks.
  • “If you scored…60 initially and…in 12 weeks…you now are scoring a 56—even that four point change…is clinically meaningful.” [24:55]
• Subjectivity Benefit: Same validity whether completed at home, with a neurologist, or with a physical therapist.

4. Maximizing the Value of Self-Assessment

• Avoid Obsessing Over Single Scores:
  • “Look for trends over three to six months…One bad score doesn’t negate progress.” [26:40]
• Expect Fluctuations: MS symptoms naturally fluctuate; expect numbers to vary.
• Share Results with Your Healthcare Team:
  • Bringing longitudinal results to provider visits offers a “head start,” improving care planning.
• Balance Numbers and Intuition:
  • “If your scores are showing that you’re not doing well, but you feel like you are…if you feel like you are, and the reason…is because you’re tripping less…your feelings matter most.” [27:22]

Notable Quotes & Memorable Moments

• On Subjectivity of Testing:
  “Manual muscle testing is extremely subjective…there's no number that is given, like, for hand strength, you can squeeze a device and a specific number will pop up…you press on a specific muscle group, and the goal is that the patient needs to resist you.” — Dr. Gretchen Hawley [03:26]

• On the Importance of How You Feel:
  “Our approach was, let's just focus on how you're feeling. Because if you're feeling stronger and you are actually walking better, does it really matter that this one specific test on this specific day showed that you scored a lower score than last time? In my opinion, as a physical therapist, not really.” — Dr. Gretchen Hawley [04:46]

• On the Value of Subjective Tools:
  “These…aren’t just ‘how do you feel’ tests. They are actual validated instruments used in MS research to show clinical differences of if some measure…is working or not working.” — Dr. Gretchen Hawley [08:32]

• On Interpreting Results:
  “One bad score doesn’t negate progress. So similar to my patient…I was explaining in the beginning…she technically scored worse on her manual muscle testing, but that didn’t negate her progress. She was still…walking better and feeling stronger.” — Dr. Gretchen Hawley [26:59]

Important Timestamps

• [02:07] — Introduction: Why tracking MS progress can be confusing and discouraging
• [03:26] — The subjectivity and potential harm of manual muscle testing
• [06:34] — Difference between subjective and objective self-assessments for MS
• [10:00] — Introduction to the Modified Fatigue Impact Scale (MFIS)
• [11:25] — Example questions from MFIS
• [13:40] — Importance of tracking trends over time, not focusing on any one score
• [17:45] — Introduction to the Multiple Sclerosis Walking Scale 12 (MSWS-12)
• [21:12] — Sample questions and explanation of the MSWS-12
• [24:47] — Four-point changes in MSWS-12 are clinically significant
• [26:40] — Recognizing the value of trends, not single test scores
• [27:22] — “Your feelings matter most”—tests guide, but don’t define, your MS journey

Additional Tips and Takeaways

• Consistency is Key: Take the questionnaires under similar conditions for best comparison.
• Accessing the Tools: Printable versions are available online; Dr. Gretchen’s “Missing Link” app includes digital forms and tracking (“Track Your Progress” course).
• Communicate with Your Healthcare Team: Bring self-tracking results to appointments or when returning to therapy; it helps providers tailor your care.
• Upcoming Episode Teaser: Next episode will cover objective outcome measures—timed walks, countable repetitions, and so on.

Guidance for Listeners

• “Try the subjective assessments today, and track again in 4–8 weeks, looking at trends not just single numbers.” [28:36]
• If you're implementing a new strategy to manage MS, these questionnaires can help you see if it’s really making a difference—empower yourself to notice and celebrate even small improvements.

For free access to printable or digital versions of the MFIS and MSWS-12, visit reputable online sources or check Dr. Hawley’s “Missing Link” app.