Cited by 213Multiple Sclerosis Research StudiesBalance, Gait, and Falls PreventionStroke Rehabilitation and Recovery

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Responsiveness and Clinically Meaningful Improvement, According to Disability Level, of Five Walking Measures After Rehabilitation in Multiple Sclerosis: A European Multicenter Study

Baert, Ilse, Freeman, Jennifer, Smedal, Tori, Dalgas, Ulrik, Romberg, Anders, Kalron, Alon, Conyers, Helen, Elorriaga, Iratxe, Gebara, Benoit, Gumse, Johanna, Heric, Adnan, Jensen, Ellen, Jones, Kari, Knuts, Kathy, Maertens de Noordhout, Benoît, Martic, Andrej, Normann, Britt, Eijnde, Bert O, Rasova, Kamila, Santoyo Medina, Carmen, Truyens, Veronik, Wens, Inez, Feys, Peter·2014·Neurorehabilitation and Neural Repair

DOI 10.1177/1545968314521010

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Abstract

Background Evaluation of treatment effects on walking requires appropriate and responsive outcome measures. Objectives To determine responsiveness of 5 walking measures and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS). Methods Walking tests were measured pre- and postrehabilitation in 290 pwMS from 17 European centers. Combined anchor- and distribution-based methods determined responsiveness of objective short and long walking capacity tests (Timed 25-Foot Walk [T25FW] and 2- and 6-Minute Walk Tests [2MWT and 6MWT] and of the patient-reported Multiple Sclerosis Walking Scale-12 [MSWS-12]). A global rating of change scale, from patients' and therapists' perspective, was used as external criteria to determine the area under the receiver operating characteristic curve (AUC), minimally important change (MIC), and smallest real change (SRC). Patients were stratified into disability subgroups (Expanded Disability Status Scale score ≤4 [n = 98], >4 [n = 186]). Results MSWS-12, 2MWT, and 6MWT were more responsive (AUC 0.64-0.73) than T25FW (0.50-0.63), especially in moderate to severely disabled pwMS. Clinically meaningful changes (MICs) from patient and therapist perspective were -10.4 and -11.4 for MSWS-12 (P Conclusions Long walking tests and patient-reported MSWS-12 were more appropriate than short walking tests in detecting clinically meaningful improvement after physical rehabilitation,…

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Do Patients with Multiple Sclerosis Derive More Benefit from Robot-Assisted Gait Training Compared with Conventional Walking Therapy on Motor Function? A Meta-analysis
Xie, X., Sun, H., Zeng, Q., Lu, P., Zhao, Y., Fan, T., & Huang, G. (2017) · Frontiers in Neurology · doi:10.3389/fneur.2017.00260 · Cited by 27
Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke
Gervasoni, E., Parelli, R., Uszynski, M., Crippa, A., Marzegan, A., Montesano, A., & Cattaneo, D. (2016) · PM&R · doi:10.1016/j.pmrj.2016.10.019 · Cited by 27
“According to Baert et al [40], an improvement greater than 21.”
MethodInfluential
Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis
Karpatkin, H., Cohen, E. T., Rzetelny, A., Parrott, J. S., Breismeister, B., Hartman, R., Luu, R., & Napolione, D. (2015) · Neurology Report · doi:10.1097/npt.0000000000000091 · Cited by 26
Rhythmic cued motor imagery and walking in people with multiple sclerosis: a randomised controlled feasibility study
Seebacher, B., Kuisma, R., Glynn, A., & Berger, T. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0021-3 · Cited by 26
“[47] and 20 % (88 m) as shown by Learmonth et al.”
BackgroundMethod
WalkWithMe
Geurts, E., Geel, F. V., Feys, P., & Coninx, K. (2019) · ACM Conference on User Modeling, Adaptation and Personalization (UMAP) · doi:10.1145/3320435.3320459 · Cited by 25
“Improvements were detected in 6MWT, MSWS-12, and IPAQ [1].”
MethodInfluentialSelf-citation
The effect of symptom-controlling medication on gait outcomes in people with multiple sclerosis: a systematic review
Behm, K. J., & Morgan, P. E. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1309581 · Cited by 25
“[29] finding that the MCID could not be accurately estimated with confidence, and Learmonth et al.”
Background
Meta-analytic and Scoping Study on Strength Training in People With Multiple Sclerosis
Manca, A., Dvir, Z., & Deriu, F. (2017) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002381 · Cited by 26
Construct Validity of the Four Square Step Test in Multiple Sclerosis
Kalron, A., & Givon, U. (2016) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2016.04.012 · Cited by 24
Self-citation
A Head-to-Head Comparison of an Isometric and a Concentric Fatigability Protocol and the Association With Fatigue and Walking in Persons With Multiple Sclerosis
Taul-Madsen, L., Dalgas, U., Kjølhede, T., Hvid, L. G., Petersen, T., & Riemenschneider, M. (2020) · Neurorehabilitation and neural repair · doi:10.1177/1545968320920250 · Cited by 25
Self-citation
Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial
Straudi, S., Marco, G. D., Martinuzzi, C., Baroni, A. V., Lamberti, N., Brondi, L., Roit, M. D., Pizzongolo, L. D. M., Basaglia, N., & Manfredini, F. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.103721 · Cited by 23
Effects of dalfampridine on multi-dimensional aspects of gait and dexterity in multiple sclerosis among timed walk responders and non-responders
Lo, A., Ruiz, J. A., Koenig, C. M., Anderson, B. M., Olson, K. M., & Triche, E. W. (2015) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2015.06.008 · Cited by 23
The Romberg ratio in people with multiple sclerosis
Kalron, A. (2017) · Gait & Posture · doi:10.1016/j.gaitpost.2017.03.016 · Cited by 22
Self-citation
Evaluation of the Multiple Sclerosis Walking Scale-12 (MSWS-12) in a Dutch sample: Application of item response theory
Mokkink, L. B., Galindo‐Garre, F., & Uitdehaag, B. M. J. (2016) · Multiple Sclerosis Journal · doi:10.1177/1352458516630821 · Cited by 21
Effect of remote ischaemic preconditioning on walking in people with multiple sclerosis: double-blind randomised controlled trial
Chotiyarnwong, C., Nair, K. P. S., Angelini, L., Buckley, E. E., Mazzà, C., Heyes, D., Ramiz, R., Baster, K., Ismail, A., Das, J., et al. (2020) · BMJ Neurology Open · doi:10.1136/bmjno-2019-000022 · Cited by 22
Sensor-based gait analyses of the six-minute walk test identify qualitative improvement in gait parameters of people with multiple sclerosis after rehabilitation
Berg‐Hansen, P., Moen, S. M., Austeng, A., Gonzales, V., Klyve, T. D., Negård, H., Seeberg, T. M., Celius, E. G., & Meyer, F. (2022) · Journal of Neurology · doi:10.1007/s00415-022-10998-z · Cited by 21
Fampridine response in MS patients with gait impairment in a real-world setting: Need for new response criteria?
Rodriguez-Leal, F. A., Haase, R., Thomas, K., Eisele, J., Proschmann, U., Schultheiß, T., Kern, R., & Ziemssen, T. (2017) · Multiple Sclerosis Journal · doi:10.1177/1352458517720043 · Cited by 21
Effects of Rehabilitation on Gait Pattern at Usual and Fast Speeds Depend on Walking Impairment Level in Multiple Sclerosis
Leone, C., Kalron, A., Smedal, T., Normann, B., Wens, I., Eijnde, B. O., & Feys, P. (2017) · International Journal of MS Care · doi:10.7224/1537-2073.2015-078 · Cited by 21
Self-citation
Exploring cued and non-cued motor imagery interventions in people with multiple sclerosis: a randomised feasibility trial and reliability study
Seebacher, B., Kuisma, R., Glynn, A., & Berger, T. (2018) · Archives of Physiotherapy · doi:10.1186/s40945-018-0045-0 · Cited by 20
Center‐Based Group and Home‐Based Individual Exercise Programs Have Similar Impacts on Gait and Balance in People With Multiple Sclerosis: A Randomized Trial
Williams, K., Choy, N. L., & Brauer, S. (2020) · PM&R · doi:10.1002/pmrj.12377 · Cited by 19
Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis
Řasová, K., Martinková, P., Soler, B., Freeman, J. A., Cattaneo, D., Jonsdottir, J., Smedal, T., Romberg, A., Henze, T., Santoyo-Medina, C., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17134774 · Cited by 19
Self-citation
A bivariate logistic regression model based on latent variables
Kristensen, S. B., & Bibby, B. M. (2020) · Statistics in Medicine · doi:10.1002/sim.8587 · Cited by 18
“The approximation in (24) shows that the effect modification on the log odds ratio scale essentially has an logistic shape.”
BackgroundMethodInfluential
Study protocol: randomised controlled trial evaluating exercise therapy as a supplemental treatment strategy in early multiple sclerosis: the Early Multiple Sclerosis Exercise Study (EMSES)
Riemenschneider, M., Hvid, L. G., Ringgaard, S., Nygaard, M. K. E., Eskildsen, S. F., Petersen, T., Stenager, E., & Dalgas, U. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-043699 · Cited by 19
Self-citation
Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial
Almuklass, A. M., Davis, L. A., Hamilton, L. D., Hebert, J. R., Álvarez, E., & Enoka, R. M. (2018) · Neurorehabilitation and neural repair · doi:10.1177/1545968317753681 · Cited by 22
“21 MSWS-12 43 ± 11 (17-57) 35 ± 13 (12-55) 38 ± 13 (16-55) .”
A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study
van Oirschot, P., Heerings, M. A. P., Wendrich, K., den Teuling, B. A. J., Dorssers, F., van Ee, R., Martens, M. B., & Jongen, P. J. (2021) · JMIR Formative Research · doi:10.2196/29128 · Cited by 17
“For the 2MWT, a MICD of <10 m was found after MS rehabilitation [30], but a change of 20% is generally considered an MICD for the T25FW [31]—another walking test that is often used in MS—that highly correlates with the 2MWT [6].”
Method
Comparing the effects of whole-body vibration to standard exercise in ambulatory people with Multiple Sclerosis: a randomised controlled feasibility study
Uszynski, M., Purtill, H., Donnelly, A., & Coote, S. B. (2015) · Clinical Rehabilitation · doi:10.1177/0269215515595522 · Cited by 19
A cross-sectional study on the relationship between cardiorespiratory fitness, disease severity and walking speed in persons with Multiple Sclerosis
Taul-Madsen, L., Dalgas, U., Hvid, L. G., & Bansi, J. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.01.024 · Cited by 17
Self-citation
Determining the minimal important change of the 6-minute walking test in Multiple Sclerosis patients using a predictive modelling anchor-based method
Oosterveer, D. M., van den Berg, C., Volker, G., Wouda, N. C., Terluin, B., & Hoitsma, E. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.103438 · Cited by 16
Construct validity of the walk ratio as a measure of gait control in people with multiple sclerosis without mobility aids
Kalron, A. (2016) · Gait & Posture · doi:10.1016/j.gaitpost.2016.04.015 · Cited by 16
Self-citation
Bipedal Hopping Reveals Evidence of Advanced Neuromuscular Aging Among People With Mild Multiple Sclerosis
Kirkland, M. C., Downer, M. B., Holloway, B. J., Wallack, E. M., Lockyer, E. J., Buckle, N. C. M., Abbott, C. L., & Ploughman, M. (2016) · Journal of Motor Behavior · doi:10.1080/00222895.2016.1241750 · Cited by 16
“The T25FWT measures how long it takes to traverse a 25-ft walkway (Phan-Ba et al., 2012) and a score of 6 s or less is considered within the normal range (Baert et al., 2014; Goldman et al., 2013).”
Background
How does strength training and balance training affect gait and fatigue in patients with Multiple Sclerosis? A study protocol of a randomized controlled trial
Callesen, J., Cattaneo, D., Brincks, J., & Dalgas, U. (2018) · Neurorehabilitation · doi:10.3233/nre-172238 · Cited by 17
“Per-spectives on clinical relevant changes are published for T25FW (Baert et al., 2014) and SSST (H. B. Jensen, Mamoei, Ravnborg, Dalgas, & Stenager, 2016).”
Self-citation
Treatment with electrical stimulation of sensory nerves improves motor function and disability status in persons with multiple sclerosis: A pilot study
Alenazy, M. S., Daneshgar, S., Petrigna, L., Feka, K., Álvarez, E., Almuklass, A. M., & Enoka, R. M. (2021) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2021.102607 · Cited by 16
The walking speed reserve in low disabled people with multiple sclerosis: Does it provide greater insight in detecting mobility deficits and risk of falling than preferred and fast walking speeds?
Kalron, A., Menascu, S., Dolev, M., & Givon, U. (2017) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2017.08.010 · Cited by 16
Self-citation
A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT
Gunn, H., Andrade, J., Paul, L., Miller, L., Creanor, S., Stevens, K. N., Green, C., Ewings, P., Barton, A., Berrow, M., et al. (2019) · Health Technology Assessment · doi:10.3310/hta23270 · Cited by 17
Self-citation
Exercise Therapy in Early Multiple Sclerosis Improves Physical Function But Not Cognition: Secondary Analyses From a Randomized Controlled Trial
Riemenschneider, M., Hvid, L. G., Petersen, T., Stenager, E., & Dalgas, U. (2023) · Neurorehabilitation and neural repair · doi:10.1177/15459683231159659 · Cited by 15
Self-citation
Symmetry in vertical ground reaction force is not related to walking and balance difficulties in people with multiple sclerosis
Kalron, A. (2016) · Gait & Posture · doi:10.1016/j.gaitpost.2016.04.010 · Cited by 15
Self-citation
Fampridine and real-life walking in multiple sclerosis: Low predictive value of clinical test for habitual short-term changes
Stellmann, J., Jlussi, M., Neuhaus, A., Lederer, C., Däumer, M., & Heesen, C. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.07.051 · Cited by 15
The ability of the instrumented tandem walking tests to discriminate fully ambulatory people with MS from healthy adults
Grinberg, Y., Berkowitz, S. H., Hershkovitz, L., Malcay, O., & Kalron, A. (2019) · Gait & Posture · doi:10.1016/j.gaitpost.2019.02.022 · Cited by 15
Self-citation
Ecological validity of walking capacity tests following rehabilitation in people with multiple sclerosis
Ehling, R., Bsteh, G., Muehlbacher, A., Hermann, K., & Brenneis, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0220613 · Cited by 15
Objectively assessed physiological, physical, and cognitive function along with patient-reported outcomes during the first 2 years of Alemtuzumab treatment in multiple sclerosis: a prospective observational study
Hvid, L. G., Stenager, E., & Dalgas, U. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11134-7 · Cited by 14
Self-citation

Authors: Baert, I., Freeman, J., Smedal, T., Dalgas, U., Romberg, A., Kalron, A., Conyers, H., Elorriaga, I., Gebara, B., Gumse, J., Heric, A., Jensen, E., Jones, K., Knuts, K., Maertens de Noordhout, B., Martic, A., Normann, B., Eijnde, B. O., Rasova, K., Santoyo Medina, C., Truyens, V., Wens, I., & Feys, P.
Affiliations: Hasselt University (BE)
University of Plymouth (GB)
Haukeland University Hospital (NO)
Aarhus University (DK)
Masku Neurological Rehabilitation Center, Masku, Finland
Sheba Medical Center (IL)
Poole Hospital NHS Foundation Trust (GB)
Eugenia Epalza Rehabilitation Center, Bilbao, Spain
National MS Center Melsbroek (BE)
Helsinki MS-Neuvola, Helsinki, Finland
Multiple Sclerosis Center, Hakadal AS, Norway
Danish Multiple Sclerosis Center (DK)
Rehabilitation and Multiple Sclerosis Center, Overpelt, Belgium
Centre Neurologique et de Réadaptation Fonctionelle, Fraiture-en-Condroz, Belgium
University Medical Center, Ljubljana, Slovenia
Nordland Hospital Trust (NO)
Charles University, Prague, Czech Republic
Hospital de Dia de Barcelona, CEMCat, Barcelona, Spain
ORCID: Baert, Ilse
Freeman, Jennifer
Dalgas, Ulrik
Romberg, Anders
Kalron, Alon
Gebara, Benoit
Normann, Britt
Eijnde, Bert O
Wens, Inez
Feys, Peter
Venue: Neurorehabilitation and Neural Repair
Publisher: SAGE Publications
Published: 2014-02-06
Volume: 28
Issue: 7
Pages: 621-631
ISSN: 0888-4390 (ISSN-L)
1545-9683
1552-6844
DOI: 10.1177/1545968314521010
OpenAlex: W2043572283
Cited by: 213
References: 34
Citations by year: 2026: 9 · 2025: 22 · 2024: 18 · 2023: 10 · 2022: 22 · 2021: 25 · 2020: 17 · 2019: 16 · 2018: 17 · 2017: 23 · 2016: 17 · 2015: 12 · 2014: 5
FWCI: 14.10
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Neurorehabilitation and neural repair (publishedVersion)
PubMed (publishedVersion)
Document Server@UHasselt (UHasselt) (submittedVersion)
Funders: Novartis
Universiteit Hasselt
Novartis Pharma
Topics: Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Keywords: multiple sclerosis, walking capacity, responsiveness, minimally important change, 2-minute walk test, 6-minute walk test, Timed 25-Foot Walk, physical rehabilitation, disability severity, Expanded Disability Status Scale, patient-reported outcomes
MeSH terms: Adult, Disability Evaluation, Europe, Humans, Male, Middle Aged, Multiple Sclerosis, Reference Standards, Walking, Treatment Outcome, Recovery of Function, Physical Therapy Modalities

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Responsiveness and Clinically Meaningful Improvement, According to Disability Level, of Five Walking Measures After Rehabilitation in Multiple Sclerosis: A European Multicenter Study

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