{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T07:44:56Z","timestamp":1788335096150,"version":"build-2803163510"},"reference-count":21,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Austrian MS Research Society"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Distinguishing relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) has reshaped understanding of disability accumulation in relapsing multiple sclerosis (RMS). The influence of differing definitions of disability accrual on event rates and RAW\/PIRA proportions remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This observational cohort study used Austrian MS Treatment Registry data (2010\u20132024). A custom algorithm evaluated 1440 definitional variants of disability accrual with varying confirmation duration, baseline modeling, and RAW\/PIRA classification, including recently proposed \u201cstandardized\u201d criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 3273 RMS patients (mean age 37.5\u2009years; 67.8% female) with \u2a7e24\u2009months follow-up, \u2a7e3 Expanded Disability Status Scale (EDSS) scores, and \u2a7e1 EDSS score per year, contributing 3525 follow-up periods. Depending on definition, disability accrual varied between 15.7% and 41.6% of follow-ups. PIRA accounted for 56.1%\u201386.3% of events across definitions, while up to 8.4% were ambiguously classified, mainly due to post-relapse re-baselining or relapses during the confirmation period. Even under \u201cstandardized\u201d criteria, 144 definitional combinations remained, with event rates ranging from 19.1% to 21.7% and PIRA contribution varying widely from 59.8% to 85.8%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PIRA predominantly drives disability accrual, yet definitional variation substantially influenced event rates and RAW\/PIRA proportions. Transparent reporting and further optimization of definitions are critical for improving comparability, interpretation, and clinical relevance in MS research and care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585251396283","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T11:49:46Z","timestamp":1765021786000},"page":"179-191","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Dissecting definitions of disability accrual in relapsing multiple sclerosis\u2014Have we reached standardization yet?"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0825-0851","authenticated-orcid":false,"given":"Gabriel","family":"Bsteh","sequence":"first","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Marti","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3486-3448","authenticated-orcid":false,"given":"Helly","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4146-5870","authenticated-orcid":false,"given":"Nik","family":"Krajnc","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8219-781X","authenticated-orcid":false,"given":"Michael","family":"Guger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pyhrn-Eisenwurzen Hospital Steyr, Steyr, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6183-2394","authenticated-orcid":false,"given":"Franziska","family":"Di Pauli","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Kraus","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria; Department of Neurology, Medical Faculty, Heinrich-Heine University, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Enzinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-1144","authenticated-orcid":false,"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Hegen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hoepner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25463"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac016"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.1568"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2015.04.001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16526"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.3331"},{"key":"e_1_3_2_9_2","first-page":"93","article-title":"Disability progression is a question of definition\u2014A methodological reappraisal by example of primary progressive multiple sclerosis","author":"Bsteh G","year":"2025","unstructured":"Bsteh G, Marti S, Krajnc N, et al. 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