Reliability and Validity of the Supine-to-Stand Test in Patients with Multiple Sclerosis.

Patients with multiple sclerosis (PwMS) may suffer severely from falling and gait disturbance. Cognitive dysfunction, a common condition in MS patients, may also increase falling rates, regardless of physical disability. We planned this study to determine the fall rate and risk factors in MS patients, follow patients for falls, and reveal the relationship between falls and cognitive dysfunction. The study was conducted on 124 patients who have RRMS diagnoses. Patients' gait speed, simultaneous gait speed during other tasks, functions of the upper extremity, balance rating, and fear of falling were evaluated with dual-task Timed-Up-and-Go-3 versions (TUG, TUG-C, TUG-M), Timed 25 Foot Walk (T25WFT), Nine Hole Peg Test (9HPT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I) tests. Cognitive functions, fatigue levels, and quality of life were measured with the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life (MSQoL) test. Two groups were formed as "fallers" and "non-faller patients". We monitored the patients in six months period. Forty-six patients fell at least once in the last one year before the study began. Fallers were older, less educated, had lower SDMT scores and higher disability scores. Non-faller patients scored lower in FES-I, TUG, and FSS tests. SDMT scores showed statistically significant, linear, positive, and moderate correlation with BBS and 9HPT scores (r = 0.307, p = 0.038, and r = 0.320, p = 0.030, respectively). We determined that advanced age, lower education level, and cognitive dysfunction adversely affect gait speed and balance. Among the fallers, those with lower SDMT and MoCA scores had higher falling rates. We determined that EDSS and BBS scores are predictive factors for falls in patients with MS. In conclusion, patients with cognitive impairment should be closely monitored for the risk of falling. Consideration of falls during follow-up examinations might be predictive of cognitive deterioration in patients with MS.

The aim of the study was to establish the test-retest reliability, clinical significance and precision of four mobility and balance measures - the Timed 25-Foot Walk, Six-minute Walk, Timed Up and Go and the Berg Balance Scale - in individuals moderately affected by multiple sclerosis. Twenty four participants with multiple sclerosis (Extended Disability Status Score 5-6.5) were assessed on four measures of mobility and balance. The Timed 25-Foot Walk, Six-minute Walk and Timed Up and Go mobility outcome measures and the Berg Balance Scale were assessed by one assessor one week apart. Intraclass correlation coefficient (ICC) analysis was carried out to determine reliability. Minimal detectable change values were calculated to determine clinical significance; the standard error of each measurement was calculated to assess precision. All four outcome measures were found to be reliable: Timed 25-Foot Walk ICC=0.94, Six-minute Walk Test ICC=0.96, Timed Up and Go ICC=0.97 and Berg Balance Scale ICC=0.96. Minimal detectable change values were as follows: Timed 25-Foot Walk=12.6 s, Six-minute Walk Test=76.2 m, Timed Up and Go=10.6 s and Berg Balance Scale=7 points. Standard errors of measurement were as follows: Timed 25-Foot Walk=4.56 s, Six-minute Walk Test=27.48 m, Timed Up and Go=3.81 s and Berg Balance Scale=3 points. The test-retest reliability of these four outcome measures was found to be good. The calculated clinical significance and precision of these measures highlight the problems of assessing a heterogeneous clinical population.

Purpose: To culturally translate and validate the Community Integration Questionnaire (CIQ) in persons with multiple sclerosis (MS). Methods: After a forward–backward translation, 105 persons with MS completed the Persian versions of the CIQ and MS Quality of Life (MSQOL) questionnaires in the first visit. The CIQ was re-administered to a sample of 45 persons with MS 7–10 days after the first session. Test–retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach’s α coefficient, respectively. Construct validity was assessed by measuring associations between subscales of the Persian CIQ (including Home Integration (HI), Social Integration (SI), and Productivity (P)) and MSQOL (including Physical and Mental Components). Dimensionality was assessed through two methods of corrected item-subscale correlation and factor analysis. Results: The acceptable level of test–retest reliability (ICC ≥0.70) was obtained for the Persian CIQ. However, Cronbach’s α coefficient of ≥0.70 was only seen for the HI. The correlations between the Persian CIQ and the Physical MSQOL were higher than those of Persian CIQ and the Mental MSQOL. The corrected item-subscale Spearman’s correlation coefficient of 0.40 was exceeded by most items of the HI and 2 items of P. A total of four factors were detected and similar to the results of item-subscale correlation, the most variability was seen for the items of SI which loaded on different factors. Conclusions: Persian CIQ seems to be a reliable and valid instrument for monitoring the level of community integration following rehabilitation in persons with MS. Some modifications need to be made in the SI of the Persian CIQ to improve extraction of information regarding community integration of persons with MS.Implications for RehabilitationThe results on psychometric properties of the Persian Community Integration Questionnaire (CIQ) are comparable with the English and Spanish versions.Persian version of the CIQ appears to be a reliable and valid instrument to assess community integration in “clinical” and “research” settings of Persian-speaking Iranians with definite diagnosis of multiple sclerosis (MS).

Aims This paper examines: the intra-rater, inter-rater and test-retest reliability of the Five-Times-Sit-To-Stand (FTSTS) test administered by experienced and inexperienced assessors; and the correlation of FTSTS test times with lower limb muscle strength and balance performance in healthy older and young people. Method The cross-sectional study investigated reliability using test batteries including: FTSTS times; hand-held dynamometer measurements of hip flexor, knee flexor and extensor, and ankle dorsiflexor and plantarflexor muscle strength; Berg Balance Scale (BBS) scores; and dynamic posturography measurements of the limits of stability (LOS). A convenience sample of 12 healthy older and 12 younger participants was recruited in the local university-based rehabilitation centre. Results The FTSTS test showed excellent intra-rater reliability (intraclass correlation coefficient (ICC) range: 0.914–0.933) and moderate intra-rater reliability (ICC range: 0.644–0.879) in healthy older and young subject groups respectively. Inter-rater reliability between assessors yielded an ICC of 0.990. Test-retest reliability (ICC range: 0.988–0.995) was excellent. FTSTS times were not significantly associated with the older subjects' lower limb muscle strength, BBS scores or LOS results. Conclusion The FTSTS has good intra-rater, inter-rater and test-retest reliability. There is no significant correlation of FTSTS times with lower limb muscle strength or balance performance in healthy older people. The FTSTS test is a reliable measurement tool whether used by experienced or inexperienced assessors. A future study with a larger sample size is required for establishing the validity of FTSTS test times in the older population.

The Canadian Occupational Performance Measure (COPM) is a generic questionnaire based on a semi-structured interview. We aimed to translate a Turkish version of the COPM (COPM-TR) and assess its reliability and validity. The COPM-TR was administered to 82 participants (42.2 ± 11.6 years and 32.9% of the participants were male) with multiple sclerosis (MS) for convergent validity and reliability analysis. The COPM-TR was administered with the Multiple Sclerosis Quality of Life-54 (MSQoL-54), and Expanded Disability Status Scale (EDSS) to determine its convergent validity. Test-retest reliability (a week interval) was assessed by the Intraclass Correlation Coefficient (ICC). There were moderately strong negative correlations between EDSS and performance and satisfaction score of COPM-TR. There were moderately strong positive correlations between MSQoL-54 physical and performance of COPM-TR and moderate positive correlations between MSQoL-54 physical and satisfaction of COPM-TR. Moderate positive correlations found between the MSQoL-54 mental and COPM-TR performance and satisfaction scores. Test re-test reliability of COPM-TR performance indicated excellent reliability. The current study demonstrates that the COPM-TR is a valid and reliable tool for measuring the perceived occupational performance and satisfaction of people with MS.

Background The IMPACT study demonstrated the benefit of interferon beta-1a (IFNβ-1a, Avonex®) two-year change in disability measured by the Multiple Sclerosis Functional Composite (MSFC) in secondary progressive multiple sclerosis (SP-MS) and health-related quality of life (HRQoL) measured by the Multiple Sclerosis Quality of Life Inventory (MSQLI). The IMPACT data permit a detailed assessment of the relation between clinical and self-reported measures. Methods IMPACT was an international randomized, double-blind, placebo-controlled trial of SP-MS patients. As the MSQLI is only in English, this report includes US and Canadian subjects. Subjects were randomized to weekly intramuscular (im) injections of INb-1a (60 mg) or placebo for 24 months. Results At baseline and follow-up, MSQLI correlations were generally stronger with the EDSS than with the MSQLI, MSFC but comparable with MSFC components. Combining the two groups, MSQLI changes for those in the best and worst MSFC change quartiles demonstrated a statistical difference for six of the 11 MSQLI scales. Linear regression demonstrated that EDSS change from baseline to month-24 scores was correlated with change in two MSQLI components. Conclusion These data support the appropriateness of using the MSQLI with individuals who have SP-MS.

Purpose: To evaluate the responsiveness of two outcome measures of participation restriction [as measured by the Community Integration Questionnaire (CIQ)] and quality of life [as measured by the Multiple Sclerosis Quality of Life (MSQOL)] following a physiotherapy intervention in patients with multiple sclerosis (MS). Method: A sample of 265 patients completed both instruments first at the time of initial visit and then after 4–6 weeks physiotherapy. In addition, patients were asked to complete the 7-point global rating scale as an external criterion of change at the post-intervention time. The responsiveness was evaluated using the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics were area under the ROC curve (AUC) and the minimally clinically important difference (MCID). The AUC and correlation coefficient greater than 0.70 were considered as acceptable responsiveness. Results: The CIQ achieved the acceptable responsiveness with an AUC of 0.81. However, the AUCs of 0.61 and 0.66 were obtained for the MSQOL physical and mental, respectively. Moreover, good correlation coefficient was obtained for the CIQ (Gamma = 0.76) while fair correlations of 0.28 and 0.33 were obtained for the MSQOL physical and mental, respectively. The MCIDs were approximately 0.50, 1.5 and 2.5 points for the CIQ, MSQOL physical and mental, respectively. Conclusions: In contrast to the MSQOL, the CIQ was responsive outcome measure in detecting changes in participation restriction of patients with MS. Moreover, the MCID values obtained in this study will help the clinicians and researchers to determine if a patient with MS has experienced a true change following physiotherapy intervention.Implications for RehabilitationThe results provide valuable information regarding to the ability of two outcome measures (i.e. the CIQ and MSQOL) to detect treatment effects in patients with MS.In contrast to the MSQOL, the CIQ is a responsive measure to changes in participation restriction due to physiotherapy.A patient with MS had to change at least 0.50 point on the CIQ, 1.5 points on the MSQOL physical and 2.5 points on the MSQOL mental to be judged as having clinically changed.

Introduction: Exercise therapy is a supplementary method for the rehabilitation of patients with multiple sclerosis (MS). The aim of this study was to compare the efficacy of an 8-week balance, resistance, and combined (balance-resistance) exercise program on balance, gait, and quality of life (QOL) in women with MS. Materials and Methods: In the present study, 30 women with MS (mean ± standard deviation of age: 34.6 ± 4.1) were randomly divided into balance, resistance, and combined exercise groups. The Berg Balance Scale, six-minute walk test (6MWT), Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire, and the Expanded Disability Status Scale (EDSS) were used, respectively, to evaluate balance, gait, and QOL. Patients underwent 3 separate intervention protocols for 8 weeks. The ANOVA, Tukey’s post hoc test, and paired t-test were used for statistical analysis (P < 0.05). Results: Balance and resistance exercises improved balance and resistance and combined exercises improved gait, but they did not significantly affect the patients’ QOL. Conclusion: It can be concluded that balance and resistance exercises have a positive effect on balance and combined and resistance exercise has positive effects on gait; thus, they can be recommended as a supplementary rehabilitation intervention for women with MS.

Background: The purpose of this study was to evaluate the validity and reliability of the Persian version of Patient Determined Disease Steps (PDDS) in both patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Methods: One hundred and forty-five patients were enrolled between May and September 2020 by consecutive sampling. Participants were asked to complete timed 25-foot walk (T25FW), 12-item Multiple Sclerosis Walking Scale (MSWS-12), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). Patients also completed Timed Up and Go (TUG) and six-minute walk (6MW) tests. Construct validity was assessed by calculating correlation between PDDS and ambulatory and demographic items. The intra-class correlation coefficient (ICC) was used to evaluate reliability. Results: One hundred and eleven patients with MS and 34 with NMOSD with disease duration of 7.6 ± 5.8 years were enrolled. Twenty-seven percent were men and mean Expanded Disability Status Scale (EDSS) was 1.8 ± 1.8. There was a significant positive correlation between EDSS and PDSS (rho = 0.64, P < 0.001) which was evident in MS subgroups and NMOSD [secondary progressive MS (SPMS): rho = 0.64, P < 0.001; relapsing-remitting MS (RRMS): rho = 0.47, P < 0.001; NMOSD: rho = 0.52, P = 0.001]. PDDS had also significant positive correlation with TUG, T25FW, and MSWS-12. PDDS had also significant negative correlation with 6MW test. PDDS had weak correlation with demographic variables. The ICC was calculated as 0.99 for PDDS. Conclusion: The Persian version of PDDS provides valid and reliable instrument to assess MS/NMOSD-related disability.

Reliability, Concurrent Validity, and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke

Parkinson’s disease (PD) is the second-most common neurodegenerative disorder in the United States. Physical activity has been shown to improve physical function in people with PD, however the correlation between many common measures of physical function is still unclear. PURPOSE: To evaluate the correlation between various measures of physical function among people with PD who exercised regularly. METHODS: Eighty-three individuals with PD (67 ± 6 years old; 8 ± 6 years since diagnosis; 54% women) were tested at baseline, and every 3 months to 1 year thereafter while participating in a twice-weekly group exercise program. Participants continued in the program for up to 10 years and completed a total of 605 examinations (range: 1-29/participant) during which they were assessed for gait velocity, six-minute walk test, timed up-and-go, single leg balance, Berg Balance Scale, grip strength, 30-second chair stand, and the Motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS). A correlation matrix across all 8 variables was calculated using Pearson correlation coefficients with a Bonferroni-adjusted alpha level of 0.002. Correlation strength was defined as strong (abs r > 0.7), moderate (0.7 ≥ abs r > 0.5), and weak (abs r ≤ 0.5). RESULTS: Mean (± SD) six-minute walk test was 340 ± 188 meters, timed up-and-go was 11.0 ± 4.4 seconds, and gait velocity was 115 ± 24 cm•sec-1. All correlations were significant (p < 0.002). Gait velocity had a strong correlation with the timed up-and-go (r = -0.72), as well as moderate correlations with the six-minute walk test (r = 0.52), Berg Balance Scale (r = 0.52), and 30-second chair stand (r = 0.55). The timed up-and-go had moderate correlations with 30-second chair stand (r = -0.61), and Berg Balance Scale (r = -0.61). The Berg Balance Scale also had a moderate correlation with the single leg balance test (r = 0.54) and UPDRS (r = -0.60). CONCLUSION: Gait velocity, timed up-and-go, and the Berg Balance Scale were all correlated with at least three other variables, indicating the greatest breadth of association. Grip strength was the only variable with no moderate or strong correlations. Further research should be conducted to determine whether these correlations change for people with Parkinson’s disease following exercise training.

Studies on robot-assisted gait training rehabilitation in multiple sclerosis have reported positive effects on mobility and quality of life. However, their effects on cognitive functions are difficult to determine because not all trials have included cognition assessments. Virtual reality-based training provides enhanced opportunity for stimulating cognitive abilities by repetitive practice, feedback information, and motivation for endurance practice. To compare the effects of innovative robot-assisted gait training combined with virtual reality versus standard robot-assisted gait training on information processing speed, sustained attention, working memory, and walking endurance in patients with multiple sclerosis. Seventeen outpatients were randomly assigned to receive robot-assisted gait training either with or without virtual reality. The robot assisted gait training + virtual reality group underwent end-effector system training engendered by virtual reality. The standard training group underwent end-effector system training. A blinded rater evaluated patients before and after treatment and at one month follow-up. The outcome measures were the Paced Auditory Serial Addition Test, Phonemic Fluency Test, Novel Task, Digit Symbol, Multiple Sclerosis Quality of Life-54, 2-Minutes Walk Test, 10-Meter Walking Test, Berg Balance Scale, gait analysis, and stabilometric assessment. Between-group comparisons showed a significant change on the 2-Minutes Walk Test (p = 0.023) after treatment in the robot-assisted gait training + virtual reality group. Significant improvement were obtained also in executive functions (p = 0.012). Both gains were maintained at the 1-month follow-up evaluation (p = 0.012, p = 0.012) in the robot-assisted gait training + virtual reality group. Both group improved quality of life after treatment (Multiple Sclerosis Quality of Life-54: Mental Health p = 0.018, Physical Health p = 0.017). Both training lead to positive influenced on executive functions. However larger positive effects on gait ability were noted after robot-assisted gait training engendered by virtual reality with multiple sclerosis. Robot-assisted gait training provides a therapeutic alternative and motivational of traditional motor rehabilitation.

Background and Purpose Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive tools to assess these risk factors and identify individuals at increased risk for falls. So, this study aimed to examine psychometric properties of the Persian-version of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) in Iranian PwMS. Methods One hundred and fifty-three PwMS completed the Persian versions of ABC, FES-I, Multiple Sclerosis Walking Scale-12 (MSWS-12), and Berg Balance Scale (BBS) in the first session. To assess the test–retest reliability, 50 PwMS filled out ABC, and FES-I in retest session with an interval of 2–7 days. Also, for evaluating responsiveness, 50 PwMS completed ABC and FES-I before and after a 4-week treatment. Results Intra-class Correlation Coefficients were 0.96 and 0.93 and Cronbach’s alpha coefficients were 0.96 and 0.99 for the ABC and FES-I, respectively. There were significant correlations (p < .001) between ABC and BBS (r = 0.55), FES-I and BBS (r = −0.56), ABC and MSWS-12 (r = −0.72), and FES-I and MSWS-12 (r = 0.76). No floor or ceiling effect was found. ABC and FES-I had acceptable responsiveness (AUC > 0.70), and their minimally important difference (MID) were 10.5 and 9.5 points, respectively. Conclusion The Persian-versions of ABC and FES-I are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings. The MID can help clinicians to make a decision based on the clinical significance of changes in patients’ status.

Background: Extensive research on both healthy subjects and patients with central nervous damage has elucidated a crucial role of postural adjustment reactions and central sensory integration processes in generating and “shaping” locomotor function, respectively. Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis (MS) patients is not fully investigated in literature.Purpose: The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training (RAGT) and sensory integration balance training (SIBT) in improving walking and balance performance in patients with MS.Methods: Twenty-two patients with MS (EDSS: 1.5–6.5) were randomly assigned to two groups. The RAGT group (n = 12) underwent end-effector system training. The SIBT group (n = 10) underwent specific balance exercises. Each patient received twelve 50-min treatment sessions (2 days/week). A blinded rater evaluated patients before and after treatment as well as 1 month post treatment. Primary outcomes were walking speed and Berg Balance Scale. Secondary outcomes were the Activities-specific Balance Confidence Scale, Sensory Organization Balance Test, Stabilometric Assessment, Fatigue Severity Scale, cadence, step length, single and double support time, Multiple Sclerosis Quality of Life-54.Results: Between groups comparisons showed no significant differences on primary and secondary outcome measures over time. Within group comparisons showed significant improvements in both groups on the Berg Balance Scale (P = 0.001). Changes approaching significance were found on gait speed (P = 0.07) only in the RAGT group. Significant changes in balance task-related domains during standing and walking conditions were found in the SIBT group.Conclusion: Balance disorders in patients with MS may be ameliorated by RAGT and by SIBT.

BackgroundEarly life stress (ELS) has been implicated in the risk of developing autoimmune disorders including multiple sclerosis (MS), but less is known about its relationship to the clinical course of MS.ObjectiveInvestigate the relationship between ELS and MS patient-reported outcomes (PRO)MethodsIn a single-center, cross-sectional study, persons with MS completed a composite of surveys assessing ELS and PRO including the adverse childhood experiences (ACE) survey, the Childhood Trauma Questionnaire, MS Performance Scales, MS Impact Scale (MSIS-29) and MS Quality of Life (MSQOL-54). Multiple linear regression models were used to assess the associations between ELS and outcomes while adjusting for potential confounding variables.ResultsA total of 133 persons with MS completed the study. ELS was significantly associated with worse outcomes on the MSQOL-54. Persons with MS with ACE score ≥ 4 were 25.6 points lower (95% CI −15.7 to −35.6) on the Mental Health Composite and 24.6 points lower (95% CI −14.4 to −34.8) on the Physical Health Composite scores of the MSQOL-54. ELS was also associated with worse outcomes on the MS Performance Scale and the MSIS-29.ConclusionIn persons with MS, a history of ELS is associated with significantly worse MS symptom burden and quality of life.