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Multicenter Study
. 2014 Sep;28(7):621-31.
doi: 10.1177/1545968314521010. Epub 2014 Feb 6.

Responsiveness and clinically meaningful improvement, according to disability level, of five walking measures after rehabilitation in multiple sclerosis: a European multicenter study

Ilse Baert  1 , Jennifer Freeman  2 , Tori Smedal  3 , Ulrik Dalgas  4 , Anders Romberg  5 , Alon Kalron  6 , Helen Conyers  7 , Iratxe Elorriaga  8 , Benoit Gebara  9 , Johanna Gumse  10 , Adnan Heric  11 , Ellen Jensen  12 , Kari Jones  3 , Kathy Knuts  13 , Benoît Maertens de Noordhout  14 , Andrej Martic  15 , Britt Normann  16 , Bert O Eijnde  17 , Kamila Rasova  18 , Carmen Santoyo Medina  19 , Veronik Truyens  13 , Inez Wens  17 , Peter Feys  17
Affiliations
Multicenter Study

Responsiveness and clinically meaningful improvement, according to disability level, of five walking measures after rehabilitation in multiple sclerosis: a European multicenter study

Ilse Baert et al. Neurorehabil Neural Repair. 2014 Sep.

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 < .01), 9.6 m and 6.8 m for 2MWT (P < .05), and 21.6 m (P < .05) and 9.1 m (P = .3) for 6MWT. In subgroups, MIC was significant from patient perspective for 2MWT (10.8 m) and from therapist perspective for MSWS-12 (-10.7) in mildly disabled pwMS. In moderate to severely disabled pwMS, MIC was significant for MSWS-12 (-14.1 and -11.9).

Conclusions: Long walking tests and patient-reported MSWS-12 were more appropriate than short walking tests in detecting clinically meaningful improvement after physical rehabilitation, particularly the MSWS-12 for moderate to severely disabled pwMS.

Keywords: clinically meaningful improvement; multiple sclerosis rehabilitation; responsiveness; walking measures.

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