Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice?

Abstract

Walking limitations are among the most visible manifestations of multiple sclerosis (MS). Regular walking assessments should be a component of patient management and require instruments that are appropriate from the clinician's and the patient's perspectives. This article reviews frequently used instruments to assess walking in patients with MS, with emphasis on their validity, reliability, and practicality in the clinical setting. Relevant articles were identified based on PubMed searches using the following terms: "multiple sclerosis AND (walking OR gait OR mobility OR physical activity) AND (disability evaluation)"; references of relevant articles were also searched. Although many clinician- and patient-driven instruments are available, not all have been validated in MS, and some are not sensitive enough to detect small but clinically important changes. Choosing among these depends on what needs to be measured, psychometric properties, the clinical relevance of results, and practicality with respect to space, time, and patient burden. Of the instruments available, the clinician-observed Timed 25-Foot Walk and patient self-report 12-Item Multiple Sclerosis Walking Scale have properties that make them suitable for routine evaluation of walking performance. The Dynamic Gait Index and the Timed Up and Go test involve other aspects of mobility, including balance. Tests of endurance, such as the 2- or 6-Minute Walk, may provide information on motor fatigue not captured by other tests. Quantitative measurement of gait kinetics and kinematics, and recordings of mobility in the patient's environment via accelerometry or Global Positioning System odometry, are currently not routinely used in the clinical setting.

Figure 1.

The Six Spot Step Test (SSST) A, Test field for the SSST; refer to text for description. B, Relationship among the SSST (solid line), the Timed 25-Foot Walk (T25FW; broken line), and the Expanded Disability Status Scale (EDSS). The dotted trend line is for the SSST, and the solid trend line is for the T25FW. Reproduced with permission from Nieuwenhuis et al.

Figure 2.

Global Positioning System (GPS) odometry Relationship between maximum objective walking distance, measured by GPS odometry, and (A) patients' subjective assessment of the impact of MS on walking, measured using the 12-Item Multiple Sclerosis Walking Scale (MSWS-12; r² = 0.46, P < .0001), and (B) walking speed, based on the Timed 10-Meter Walk test (r² = 0.75, P < .0001). Reproduced with permission from Créange et al.

Figure 3.

Bivariate plot of the relationship between the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) score and accelerometer counts There was a strong correlation between the two variables, as indicated by the Pearson correlation coefficient (–0.64; P = .001) and the Spearman rank correlation coefficient (–0.68; P = .001). Reproduced with permission from Motl and Snook.