Highlights
- •The Disease Step Rating Scale is a useful tool for categorizing the mobility of people with multiple sclerosis.
- •Clinical gait and balance measures were statistically different across many disease steps and met most previously reported minimally detectable change levels and all minimally important change levels.
- •The 6-minute walk test better differentiated performance in those with mild disability.
- •The 10-m walk test and 25-foot walk test demonstrated greater differences between individuals with moderate to severe disability.
- •The Berg Balance Scale more consistently discriminated across the disease spectrum, showing differences between every 2 disease steps.
Abstract
Objectives
To explore differences in gait endurance, speed, and standing balance in people with
multiple sclerosis (MS) across the Disease Step Rating Scale, and to determine if
differences are statistically significant and clinically meaningful.
Design
Observational study.
Setting
Community rehabilitation - primary health care center.
Participants
Community-dwelling people with MS (N=222; mean age, 48±12y; 32% men).
Interventions
Not applicable.
Main Outcome Measures
Participants were categorized using the Disease Step Rating Scale. Demographics and
clinical measures of gait endurance (6-minute walk test [6MWT]), gait speed (10-m
walk test [10MWT] and 25-foot walk test [25FWT]), and balance (Berg Balance Scale
[BBS]) were recorded in 1 session. Differences in these parameters across categories
of the Disease Step Rating Scale were explored, and clinically meaningful differences
were identified.
Results
The 6MWT showed a greater number of significant differences across adjacent disease
steps in those with less disability (P<.001), whereas the 10MWT and 25FWT demonstrated more significant changes in those
with greater disability (P<.001). The BBS demonstrated significant differences across the span of the Disease
Step Rating Scale categories (P<.001). Differences in gait and balance between adjacent Disease Step Rating Scale
categories met most previously established levels of minimally detectable change and
all minimally important change scores.
Conclusions
Our findings support the Disease Step Rating Scale is an observational tool that can
be used by health professionals to categorize people with MS, with the categories
reflective of statistically significant and clinically meaningful differences in gait
and balance performance.
Keywords
List of abbreviations:
10MWT (10-m walk test), 25FWT (25-foot walk test), 6MWT (6-minute walk test), BBS (Berg Balance Scale), EDSS (Expanded Disability Status Scale), MDC (minimally detectable change), MIC (minimally important change), MS (multiple sclerosis)To read this article in full you will need to make a payment
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References
- Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.Mult Scler. 2006; 12: 620-628
- Direction-specific impairments of limits of stability in individuals with multiple sclerosis.Ann Phys Rehabil Med. 2015; 58: 145-150
- Decreased postural balance in multiple sclerosis patients with low disability.Int J Rehabil Res. 2011; 34: 53-58
- Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory.Phys Ther. 2008; 88: 176-190
- Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners.Patient. 2011; 4: 189-201
- Impact of loss of mobility on instrumental activities of daily living and socioeconomic status in patients with MS.Curr Med Res Opin. 2010; 26: 493-500
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- Kurtzke scales revisited: the application of psychometric methods to clinical intuition.Brain. 2000; 123: 1027-1040
- Disease steps in multiple sclerosis: a simple approach to evaluate disease progression.Neurology. 1995; 45: 251-255
- Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression.Mult Scler. 1999; 5: 349-354
- Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change.Health Qual Life Outcomes. 2006; 4: 54
- The reliability, precision and clinically meaningful change of walking assessments in multiple sclerosis.Mult Scler. 2013; 19: 1784-1791
- Reliability and clinical significance of mobility and balance assessments in multiple sclerosis.Int J Rehabil Res. 2012; 35: 69-74
- Validity of Minimal clinically important difference values for the Multiple Sclerosis Walking Scale-12?.Eur Neurol. 2014; 71: 196-202
- Responsiveness and clinically meaningful improvement, according to disability level, of five walking measures after rehabilitation in multiple sclerosis: a European multicenter study.Neurorehabil Neural Repair. 2014; 28: 621-631
- Minimally important clinical difference of the timed 25-foot walk test: results from a randomized controlled trial in patients with multiple sclerosis.Curr Med Res Opin. 2012; 28: 49-56
- New diagnostic criteria for multiple sclerosis: guidelines for research protocols.Ann Neurol. 1983; 13: 227-231
- Two-, six-, and 12-minute walking tests in respiratory disease.BMJ. 1982; 284: 1607-1608
- Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors.Physiother Can. 2011; 63: 166-180
- Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years.J Cardiopulm Rehabil. 2001; 21: 87-93
- Reliability of physical functioning measures in ambulatory subjects with MS.Physiother Res Int. 2005; 10: 93-109
- Community walking can be assessed using a 10-metre timed walk test.Mult Scler. 2011; 17: 980-990
- Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants.Age Ageing. 1997; 26: 15-19
- Validity of performance scales for disability assessment in multiple sclerosis.Mult Scler. 2007; 13: 1176-1182
- A corrected version of the timed-25 foot walk test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients.Neurorehabilitation. 2012; 30: 261-266
- Balance and its measurement in the elderly; a review.Physiother Can. 1989; 41: 240-246
- Risks of falls in subjects with multiple sclerosis.Arch Phys Med Rehabil. 2002; 83: 864-867
- Validity of six balance disorders scales in persons with multiple sclerosis.Disabil Rehabil. 2006; 28: 789-795
- Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders.Phys Ther. 2013; 93: 158-167
- Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?.Arch Phys Med Rehabil. 2004; 85: 234-239
- Threshold Berg balance scale scores for gait-aid use in elderly subjects: a secondary analysis.Physiother Can. 2010; 62: 133-140
Article info
Publication history
Published online: April 21, 2016
Footnotes
Presented to the Australian Physiotherapy Association, October 18, 2013, Melbourne, VIC, Australia.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
