Ecological validity of walking capacity tests following rehabilitation in people with multiple sclerosis.

Rainer Ehling,Christian Brenneis,Andreas Muehlbacher,Kay Hermann,Gabriel Bsteh,J Lucas Mckay

doi:10.1371/journal.pone.0220613

Rainer Ehling, Christian Brenneis + Show 4 more

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https://doi.org/10.1371/journal.pone.0220613

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Abstract

BackgroundWalking capacity tests are commonly used to evaluate interventions aiming at reducing walking impairment in people with multiple sclerosis (pwMS). However, their ecological validity has recently been questioned. The aim of the present study was to investigate the ecological validity of the 2- and 6-minutes walking tests (2MWT and 6MWT) and the timed 25-foot walk (T25FW) after 28 days of multidisciplinary inpatient rehabilitation (MIR) in pwMS using accelerometry.MethodsPwMS wore an accelerometer on 7 consecutive days within a 14-day period prior to MIR, performed 2/6MWT and T25FW at the beginning and at the end of MIR, followed by another 7 consecutive days of accelerometry.ResultsSignificant improvements in 2/6MWT and T25FW after MIR in a cohort of 76 pwMS (mean age = 47.9, SD 8.3 years) were overall correlated to a significant gain in everyday life mobility (total steps/day). However, the correlation was strongly dependent on pre-existing walking disability defined by EDSS and only pwMS with “mild” walking impairment (EDSS 2–3.5) were able to transfer benefits measurable by walking capacity tests into improved everyday life mobility, while pwMS with “moderate to severe” walking disability (EDSS 4–6.5) were not.ConclusionEcological validity of changes in walking capacity tests following MIR is strongly dependent on pre-existing walking impairment.

Highlights

Walking impairment in people with multiple sclerosis is highly prevalent, occurs early in the disease course, and has a profound negative effect on health-related quality of life (HRQoL) [1,2]
Ecological validity of changes in walking capacity tests following multidisciplinary inpatient rehabilitation (MIR) is strongly dependent on pre-existing walking impairment
Of the 86 consecutively recruited people with multiple sclerosis (pwMS), ten had to be excluded from the final analysis: three pwMS could not be assessed after MIR because of unforeseen medical circumstances leading to premature termination of MIR; accelerometer data from another six pwMS was either insufficient or worn after a period of more than 14 days after MIR (n = 1); one patient refused to wear the accelerometer after MIR

Summary

Introduction

Walking impairment in people with multiple sclerosis (pwMS) is highly prevalent, occurs early in the disease course, and has a profound negative effect on health-related quality of life (HRQoL) [1,2]. It was associated with an increased risk for cardiovascular diseases [3]. Walking capacity tests are commonly used to evaluate interventions aiming at reducing walking impairment in people with multiple sclerosis (pwMS). Their ecological validity has recently been questioned. The aim of the present study was to investigate the ecological validity of the 2- and 6-minutes walking tests (2MWT and 6MWT) and the timed 25-foot walk (T25FW) after 28 days of multidisciplinary inpatient rehabilitation (MIR) in pwMS using accelerometry

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