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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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
