Construct validity of the walk ratio as a measure of gait control in people with multiple sclerosis without mobility aids.

Ambulatory limitations are a key component of disability in people with multiple sclerosis (PwMS). Various tools are employed to assess walking performance in PwMS; however, no ideal measure has as yet been attained. In this situation, a walk ratio might be more advantageous compared with other gait measures. The walk ratio, a simple index for describing temporal and spatial co-ordination, denotes the relationship between step length and cadence during walking. Hence, the primary objective of this study was to determine the relationship between the walk ratio and measures of other theoretically related constructs. The walk ratio was studied using the GAITRite™ system (CIR Systems, Inc. Havertown, USA). The study group included 229 PwMS (143 women) and a mean disease duration of 5.8 (SD=7.1) years. The walk ratio score of the total sample was 5.3 (SD=0.8). Significant differences based on the expanded disability status scale (EDSS) scores (F=11.616, P<0.001) were observed between the neurological disability subgroups. Scores of the very mild (EDSS 0-2.0), mild (EDSS 2.5-4.0) and moderate (EDSS 4.5-5.5) groups were 5.5 (SD=0.7), 5.2 (SD=0.7), 4.9 (SD=0.9), respectively. In terms of fall status, the MS fallers demonstrated a significant lower walk ratio compared to the MS non-fallers; 5.1 (SD=0.8) vs. 5.5 (SD=0.7); P<0.001. Modest significant correlation scores were found between walk ratio and ambulation tests. Scores were slightly higher in the short walking tests, timed 25-foot walk and timed up and go tests (Pearson's rho=0.369, 0.364) compared to the 6 and 2-min walk time tests (Pearson's rho=0.344, 0.308). Collectively, the current study supports the construct validity of the walk ratio index in PwMS without mobility aids.

Kalron A 《-》

Further construct validity of the Timed Up-and-Go Test as a measure of ambulation in multiple sclerosis patients.

Kalron A ，Dolev M ，Givon U 《-》

Symmetry in vertical ground reaction force is not related to walking and balance difficulties in people with multiple sclerosis.

Analysis of vertical ground reaction force (GRF) symmetry may benefit people with multiple sclerosis (PwMS) since it can detect important differences in gait mechanics which have not previously been discussed in the related literature. Therefore, the primary objective of the current study was to determine whether symmetry of the vertical GRF during gait is associated with validated gait and balance tests in PwMS. Additionally, we examined whether the symmetry of the vertical GRF differs between MS fallers, non-fallers and between neurological disability levels. Gait and balance data were collected from 402 PwMS (249 women) with a mean age of 42.1 (S.D=14.1) years. Vertical GRF parameters were obtained using the Zebris FDM-T Treadmill (Zebris Medical GmbH, Germany). Clinical gait and balance tests included the 2 and 6-min Walk Test, Timed Up and Go Test, Timed 25 Foot Walk, Four Square Step Test, Multiple Sclerosis Walking Scale questionnaire, Modified Fatigue Impact Scale and the Falls Efficacy Scale International questionnaire. The vertical GRF symmetry index score of the total sample was 3.7 (SD=3.1). In terms of fall status, non-significant differences were observed between the fallers and non-faller groups and between the neurological disability subgroups. Non-significant correlation scores were found between the vertical GRF symmetry index, all clinical walking and balance tests and self-reported questionnaires. We suggest clinicians, especially those involved in physical rehabilitation, accord low priority to this gait phenomenon in the MS population.

Kalron A 《-》

Construct Validity of the Four Square Step Test in Multiple Sclerosis.

To expand the construct validity of the Four Square Step Test (FSST) in people with multiple sclerosis (PWMS). Cross-sectional study. Multiple sclerosis center. PWMS (N=218; 133 women, 85 men; mean age, 43.2±13.5y; mean disease duration, 7.5±7.7y since diagnosis) were enrolled in the study. The Expanded Disability Status Scale score was 3.1±1.3, indicating minimal to moderate neurologic disability. Not applicable. The FSST, posturography measures, 2-minute walk test, timed Up & Go test, timed 25-foot walk, fall status, Falls Efficacy Scale International, Modified Fatigue Impact Scale, instrumented cognitive assessment, and 12-item Multiple Sclerosis Walking Scale. The FSST score of the total sample was 11.0±4.9. Significant differences were observed between the very mild, mild, and moderate disability groups: 8.8±3.4, 11.1±4.9, and 14.1±5.3, respectively. In terms of fall status, the fallers demonstrated a significant slower FSST score than the nonfallers (12.5±5.7 vs 9.0±2.6, respectively). Modest significant correlation scores were found between the FSST and the timed Up & Go test and 2-minute walk test (Pearson ρ=.652 and ρ=-.575, respectively). In terms of posturography, all measures were significantly associated with the FSST scores. A significant positive relation was observed with the visual spatial cognitive domain (Pearson ρ=-.207). The current study supports and broadens the construct validity of the FSST in PWMS.

Kalron A ，Givon U 《-》

Association between gait variability, falls and mobility in people with multiple sclerosis: A specific observation on the EDSS 4.0-4.5 level.

Kalron A 《-》