Fig. 2.

Widening the focus on hidden symptoms of MS. PIRA may frequently remain undetected due to the low granularity of clinical measures. Widening the focus on clinical features beyond motor disability alone (as measured by the EDSS) could improve the definition and identification of PIRA, as it occurred when assessments of walking ability (using the T25FWT) and manual dexterity (using the 9HPT) were included⁹⁵ (see text for details). MS: Multiple Sclerosis; EDSS: Expanded Disability Status Scale; 9HPT: 9-Hole Peg Test; T25FWT: Timed 25-foot Walk Test; PIRA: Progression Independent of Relapse Activity.