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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
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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“The twelve item Multiple Sclerosis Walking Scale (MSWS-12) (30), a self-reported questionnaire on walking ability in MS, is shown to correlate with improvement after rehabilitation, especially in early phases of the disease (31).”
From The instrumented single leg stance test detects early balance impairment in people with multiple sclerosis (2023) · cites this paper as [31]
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ResultOutcome measures assisting treatment optimization in multiple sclerosis
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“We recommend that future studies may investigate the Timed 25-Foot Walk [48] or Global Rating Scales [30, 49] as external criteria for the responsiveness of the Six Spot Step Test.”
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Metadata
- 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
- 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
- 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
- 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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