Multiple Sclerosis Walking Scale-12 Scores Research Articles

Validation of scores from a telephone administered multiple sclerosis walking scale-12 in persons with multiple sclerosis

BackgroundThe Multiple Sclerosis Walking Scale-12 (MSWS-12) has typically been delivered through paper-and-pencil or computer-based administration. PurposeThis study examined the validity of inferences from scores derived via a telephone administration of the MSWS-12 applied as part of screening of participants with walking dysfunction into a clinical trial of exercise training in MS. MethodThe MSWS-12 was administered on two occasions separated by approximately 2 weeks through the telephone and then in-person (i.e., computer-based administration). Participants further completed the Patient Determined Disease Steps (PDDS) scale, timed 25-foot walk (T25FW), six-minute walk (6MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an expanded disability status scale (EDSS) score. The primary set of data (Full Sample) for analyses included all persons who passed the telephone screening for inclusion with MSWS-12 scores between 25 and 75 (N = 374). The secondary set of data (Truncated Sample) included only persons with MSWS-12 scores between 25 and 75 for both the telephone and computer administrations of the MSWS-12 (N = 248). ResultsThe results in the Full Sample indicated a difference in overall and item levels scores between the telephone and computer data collections, and the computer version had higher internal consistency and stronger unidimensionality. Nevertheless, MSWS-12 scores from both modes of administration had comparable correlations with the T25FW, 6MW, EDSS, PDDS, MFIS, and MSIS-29, but the correlation between the two MSWS-12 administrations did not approach unity. There was a systematic difference in scores between telephone and computer administrations across levels of walking dysfunction based on a Bland-Altman plot, and the difference was predicted by MFIS physical, 6MW, and EDSS scores. The comparison of results between the Full and Truncated Samples suggested that the primary analysis might have been influenced by the larger range of scores on the computer than telephone administrations of the MSWS-12. ConclusionThe telephone administration of the MSWS-12 provides an efficient and cost-effective measure of walking dysfunction in persons with MS.

Do depressive and anxiety symptoms influence the construct validity of Multiple Sclerosis Walking Scale-12 scores?

Walking dysfunction, depression, and anxiety are prevalent, burdensome, and interrelated outcomes in persons with multiple sclerosis (MS). The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a common patient-reported outcome (PRO) of walking dysfunction in research and practice involving MS, but the construct validity of its scores might be influenced by symptoms of depression and anxiety. This study examined if symptoms of depression and anxiety influenced the construct validity of MSWS-12 scores. The sample included 189 participants with MS who completed the MSWS-12, Hospital Anxiety and Depression Scale (HADS-Depression subscale [HADS-D] and HADS-Anxiety subscale [HADS-A]), 6-minute walk (6MW), and timed 25-foot walk (T25FW). We conducted bivariate correlation analysis to examine the associations between MSWS-12 scores and both the 6MW and T25FW, while controlling for HADS-D and HADS-A scores. MSWS-12 scores were significantly correlated with the 6MW (r = -.752), T25FW (r = .694), HADS-D (r = .405), and HADS-A (r = .235). The correlations between MSWS-12 and 6MW (pr = -.725) and T25FW (pr = .685) did not change when controlling for HADS-D and HADS-A scores. The correlations between MSWS-12 and 6MW (r = -.708 and r = -.726) and T25FW (r = .687 and r = .748) were strong in subsamples with elevated HADS-D and HADS-A scores. Our results strengthen the validity evidence for MSWS-12 scores as a PRO of walking dysfunction in MS, including among those with symptoms of depression and anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multiple Sclerosis Walking Scale-12 (MSWS-12) and its Relationship With Fatigue in People With Multiple Sclerosis

Background and Objectives: Walking disorder is one of the most important manifestations of multiple sclerosis (MS), and indicates the progression of the disease. Fatigue and walking are considered as key symptoms affecting the patient’s quality of life. Therefore, this study aimed to investigate the relationship between walking status and fatigue, in people with MS. Methods: A total number of 60 Iranian patients with MS completed the Persian version of the Multiple Sclerosis Walking Scale-12 (MSWS-12), the Modified Fatigue Impact Scale, and the Hospital Anxiety and Depression Scale. Data were analyzed using SPSS V. 20 software. The multivariate correlation and linear regression analyses were conducted to investigate the relationship between fatigue, anxiety, depression, demographic characteristics, and MSWS-12 scores. Results: Gait problems were observed in 46.7% of the study participants. Also, the MSWS-12 scores were significantly associated with fatigue severity (P=0.001), in these patients. Moreover, depression, cognitive status, anxiety, and gait status were the most important factors affecting fatigue. Conclusion: According to the present results, the presence of depression, cognitive problems, anxiety, and gait disorders are the most important factors affecting fatigue, in patients with MS.

Self-efficacy and walking performance across the lifespan among adults with multiple sclerosis.

Aim: We examined associations between self-efficacy and walking mobility across the lifespan in multiple sclerosis (MS). Methods: This study included 39 young, 44 middle-aged and 41 older adults with MS who completed the Six-Minute Walk (6MW), Timed 25-foot Walk (T25FW), MS Walking Scale-12 (MSWS-12) and MS Self-efficacy Scale. Results: Self-efficacy for function explained 45 and 48% of variance in MSWS-12 scores for young and older adults with MS, respectively; 13, 29 and 23% of variance in T25FW for young, middle-aged and older adults, respectively; and 28, 31 and 28% of variance in 6MW for young, middle-aged and older adults with MS, respectively. Conclusion: This study highlights self-efficacy as a target of in-walking mobility interventions across the lifespan in MS.

The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: A randomized double-blind clinical trial study

Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. Methods: In a single-center randomized double-blind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the Cz point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. Results: On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. Conclusion: tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients' mobility in daily activities.

Naturally occurring change in Multiple Sclerosis Walking Scale-12 scores over time in multiple sclerosis.

This study examined the trajectory and pattern of naturally occurring change in perceived walking impairment over a 30-month period in relapsing-remitting multiple sclerosis (RRMS). Two hundred and sixty-nine persons with RRMS completed the 12-item Multiple Sclerosis Walking Scale (MSWS-12) every 6months over a 30-month period. Data were analyzed using latent growth curve modeling and latent class growth curve modeling. Latent growth curve modeling demonstrated that a linear trajectory adequately described the group-level pattern of change in MSWS-12 scores over time. Latent class growth curve modeling supported a three-class model for describing the heterogeneity of changes in MSWS-12 scores over time. Walking impairment does change over time in RRMS, and this can be described by three patterns of change trajectories that differed based on initial status of walking impairment.

Predicting falls in multiple sclerosis: Do electrophysiological measures have a better predictive accuracy compared to clinical measures?

BackgroundThe risk of falls in people with Multiple Sclerosis (MS) is much greater than that of the general population due to impaired coordination, gait, sensation, muscle tone, strength, and cognition. These MS related falls hamper the day to day living of these individuals and are one of the prime factors aggravating the disease related morbidity. The fear of falling itself may make these individuals more dependent and hinder their professional and leisurely activities. Hence, the significance of identifying individuals who are at risk of falling and instituting preventive counter-measures cannot be overemphasized. Various simple clinical tests and questionnaires have been recommended for this purpose, but are far from ideal. ObjectiveThe objective was to find accurate measures to predict a future fall in MS patients. We also aimed to enquire about the prevalence of falls in MS population and its clinical profile which included detailed history about the past falls, Expanded disability status scale (EDSS) scores, Timed 25 foot walk (T25FW) scores, Activities specific balance confidence (ABC) scores, Falls efficacy scale international (FESI) scores, Multiple Sclerosis Walking Scale 12 (MSWS12) questionnaire. Design/MethodsThis was a prospective cohort study conducted at the Institute of Neurology, Chennai from January 2015 to August 2017. MS patients of any subtype attending Neurology OPD satisfying revised 2010 McDonald criteria were recruited. 134 subjects with MS consented to participate in this study and 113 of them who met the criteria were included. Baseline history was obtained about the number of falls in the previous year. EDSS, T25FW, ABC, FESI, and MSWS12 scores were obtained at the baseline. VEMP and SEP tests were done and the baseline P13/N23 cVEMP latencies, N10 oVEMP latency, and P37 lower limb SEP latency were obtained. These subjects were followed up for one year and were enquired if they had fallen during that period and the number of falls was recorded. Logistic regression models were used to compute the area under receiver operating characteristic curve (AUC) for each variable tested. Pearson correlation coefficients were calculated for each variable with the number of future falls. ResultsAmong the 113 patients, 72% (n = 81) had one or more falls during follow-up. Among all variables tested P13 cervical VEMP latency had the highest predictive accuracy (AUC = 0.820) followed by N10 ocular VEMP latency (AUC = 0.794) and P37 SEP latency (AUC = 0.732). P13 latency also had the highest correlation coefficient (R = 0.689, R2 = 0.475) with the number of future falls. ConclusionP13, N10 and P37 latencies were the most accurate in predicting a future fall when compared to clinical measures.

Validity of Minimal Clinically Important Difference Values for the Multiple Sclerosis Walking Scale-12?

Background and Objective: Minimal clinically important difference (MCID) values of 4 and 6 points have been proposed for interpreting meaningful change in Multiple Sclerosis Walking Scale-12 (MSWS-12) scores. This study examined the validity of those MCID values based on capturing corresponding changes in other walking outcomes in persons with multiple sclerosis (MS). Methods: On 2 occasions separated by 6 months, 82 persons with MS completed the MSWS-12, timed 25-ft walk (T25FW), 6-min walk (6MW), and gait analysis, and then wore an accelerometer over a 7-day period. We generated change scores for the MSWS-12 and formed groups of stable, worsened, and improved perceived walking based on both 4- and 6-point changes. The groups were compared for corresponding changes in other walking measures over time using mixed-model ANOVAs. Results: The mixed-model ANOVAs did not identify statistically significant group-by-time interactions on the T25FW (p = 0.98 and p = 0.67), the 6MW (p = 0.89 and p = 0.72), gait (p = 0.54 and p = 0.21), or accelerometry (p = 0.40 and p = 0.68) for MCID values of 4- or 6-point changes in MSWS-12 scores. Conclusions: We did not confirm that MCID values of 4 and 6 points for the MSWS-12 correspond with changes in performance, gait, and free-living assessments of walking in MS.

Cognitive processing speed has minimal influence on the construct validity of Multiple Sclerosis Walking Scale-12 scores

BackgroundThe Multiple Sclerosis Walking Scale-12 (MSWS-12) has been a commonly used patient reported outcome for measuring walking impairment in research involving multiple sclerosis (MS). ObjectiveWe examined the possibility that cognitive processing speed (CPS) influences the association between MSWS-12 scores and other measures of ambulation (i.e., construct validity). Methods96 MS patients completed the MSWS-12, underwent a neurological examination for generating an Expanded Disability Status Scale (EDSS) score, and completed the Symbol Digit Modalities Test (SDMT), Timed 25-Foot Walk (T25FW), 4 trials on the GAITRite™ for generating the functional ambulatory profile (FAP) score, and Six-minute Walk (6MW). ResultsThe SDMT was significantly correlated with MSWS-12 scores (r=−.428) and T25FW (r=−.459), 6MW (r=.512), FAP (r=.275), and EDSS (r=−.404) scores. There were statistically significant correlations between MSWS-12 and T25FW (r=.568), 6MW (r=−.680), FAP (r=−.595), and EDSS (r=.737) scores. Lastly, four separate hierarchical linear regression analyses indicated that, after controlling for age, gender, disease duration, and clinical course, T25FW, 6MW, FAP, and EDSS scores individually were significant correlates of MSWS-12 scores, and the associations (i.e., standardized beta-coefficients) were still statistically significant with minimal attenuation when controlling for SDMT scores. ConclusionThere was minimal evidence that CPS influenced the construct validity of MSWS-12 scores.

Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis

BackgroundThe Patient Determined Disease Steps (PDDS) is a promising patient-reported outcome (PRO) of disability in multiple sclerosis (MS). To date, there is limited evidence regarding the validity of PDDS scores, despite its sound conceptual development and broad inclusion in MS research. This study examined the validity of the PDDS based on (1) the association with Expanded Disability Status Scale (EDSS) scores and (2) the pattern of associations between PDDS and EDSS scores with Functional System (FS) scores as well as ambulatory and other outcomes.Methods96 persons with MS provided demographic/clinical information, completed the PDDS and other PROs including the Multiple Sclerosis Walking Scale-12 (MSWS-12), and underwent a neurological examination for generating FS and EDSS scores. Participants completed assessments of cognition, ambulation including the 6-minute walk (6 MW), and wore an accelerometer during waking hours over seven days.ResultsThere was a strong correlation between EDSS and PDDS scores (ρ = .783). PDDS and EDSS scores were strongly correlated with Pyramidal (ρ = .578 &ρ = .647, respectively) and Cerebellar (ρ = .501 &ρ = .528, respectively) FS scores as well as 6 MW distance (ρ = .704 &ρ = .805, respectively), MSWS-12 scores (ρ = .801 &ρ = .729, respectively), and accelerometer steps/day (ρ = -.740 &ρ = -.717, respectively).ConclusionThis study provides novel evidence supporting the PDDS as valid PRO of disability in MS.

Accelerometry as a measure of walking behavior in multiple sclerosis.

Accelerometry has been identified as a possible ecologically valid and objective approach for measuring community ambulation in multiple sclerosis (MS). This study provides a validation of accelerometer output based on associations with Expanded Disability Status Scale (EDSS), Patient Determined Disease Steps (PDDS) Scale, and Multiple Sclerosis Walking Scale-12 (MSWS-12) scores, timed 25-foot walk (T25FW) and 6-min walk (6MW) performance, oxygen cost (O(2) cost) of walking, and spatial and temporal parameters of gait. 256 persons with MS completed the PDDS and MSWS-12, underwent an examination for the generation of an EDSS score, undertook two T25FW tests and a 6MW while wearing a portable metabolic unit for measuring the O(2) cost of walking, completed two trials of comfortable walking on a GAITRite electronic walkway for measuring spatial and temporal parameters of gait, and then wore an Actigraph accelerometer during the waking hours of a 7-day period. The accelerometer output was significantly correlated with EDSS (ρ = -0.522), PDDS (ρ = -0.551), and MSWS-12 (ρ = -0.617) scores, T25FW (ρ = -0.595) and 6MW (ρ = 0.630) performance, and O(2) cost of walking (ρ = -0.457). Regarding gait parameters, the accelerometer output was significantly correlated with velocity (ρ = 0.420), cadence (ρ = 0.349), step time (ρ = -0.353), step length (ρ = 0.395), double support (ρ = -0.424), and single support (ρ = 0.400). We provide comprehensive evidence from a large sample of persons with MS that further supports accelerometry as a measure of walking behavior.

Further Validation of Multiple Sclerosis Walking Scale-12 Scores Based on Spatiotemporal Gait Parameters

ObjectiveTo examine the association between Multiple Sclerosis Walking Scale-12 (MSWS-12) scores and spatiotemporal parameters of gait as indicators of gait quality among ambulatory persons with multiple sclerosis (MS). DesignCross-sectional study. SettingUniversity research laboratory. ParticipantsCommunity-residing persons with MS (N=268). InterventionNot applicable. Main Outcome MeasuresMain outcome measures included the MSWS-12 and spatial and temporal gait parameters (walking speed, cadence, step length, step time, base of support [ie, the distance between 1 footfall and the line of progression of the opposing foot], and percentage of gait cycle spent in double support). Secondary outcomes included the timed 25-foot walk (T25FW), 6-minute walk (6MW), and Patient-Determined Disease Steps scale. ResultsMSWS-12 scores were significantly correlated with walking speed (r=–.59), cadence (r=–.50), step length (r=–.53), step time (r=.46), base of support (r=.29), and percentage of the gait cycle spent in double support (r=.54). MSWS-12 scores further were significantly correlated with T25FW (r=.57) and 6MW (r=–.75) scores. ConclusionsSuch findings suggest that the MSWS-12 captures aspects of walking quality, assessed as spatiotemporal parameters of gait, in addition to walking speed and endurance in persons with MS.

Accelerometry and Its Association With Objective Markers of Walking Limitations in Ambulatory Adults With Multiple Sclerosis

Motl RW, Dlugonski D, Suh Y, Weikert M, Fernhall B, Goldman M. Accelerometry and its association with objective markers of walking limitations in ambulatory adults with multiple sclerosis. Objective To validate accelerometry based on its correlations with 6-minute walk distance (6MWD) and oxygen cost of walking as objective markers of walking limitations in multiple sclerosis (MS). Design Cross-sectional. Setting Laboratory and general community. Participants Ambulatory participants with MS (N=26) who resided in the local community. Interventions Not applicable. Main Outcome Measures Patient Determined Disease Steps (PDDS) scale and Multiple Sclerosis Walking Scale-12 (MSWS-12); 6-minute walk test while wearing a portable metabolic unit for measuring the 6MWD and oxygen cost of walking; accelerometer during the waking hours of a 7-day period. Results The average of total daily movement counts from the accelerometer correlated significantly and strongly with MSWS-12 scores (ρ=–.681, P=.001), PDDS scores (ρ=–.609, P=.001), 6MWD (ρ=.519, P=.003), and oxygen cost of walking (ρ=–.541, P=.002). Conclusions We provide evidence that further supports the validity of accelerometry as a measure of walking limitations in ambulatory persons with MS.

Accelerometry in persons with multiple sclerosis: Measurement of physical activity or walking mobility?

Objective Motion sensors such as accelerometers have been recognized as an ideal measure of physical activity in persons with MS. This study examined the hypothesis that accelerometer movement counts represent a measure of both physical activity and walking mobility in individuals with MS. Methods The sample included 269 individuals with a definite diagnosis of relapsing–remitting MS who completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), International Physical Activity Questionnaire (IPAQ), Multiple Sclerosis Walking Scale-12 (MSWS-12), Patient Determined Disease Steps (PDDS), and then wore an ActiGraph accelerometer for 7 days. The data were analyzed using bivariate correlation and confirmatory factor analysis. Results The results indicated that (a) the GLTEQ and IPAQ scores were strongly correlated and loaded significantly on a physical activity latent variable, (b) the MSWS-12 and PDDS scores strongly correlated and loaded significantly on a walking mobility latent variable, and (c) the accelerometer movement counts correlated similarly with the scores from the four self-report questionnaires and cross-loaded on both physical activity and walking mobility latent variables. Conclusion Our data suggest that accelerometers are measuring both physical activity and walking mobility in persons with MS, whereas self-report instruments are measuring either physical activity or walking mobility in this population.

Continued validation of the Symptom Inventory in multiple sclerosis

Objective This study examined the construct, discriminant, and incremental validity of scores from the short (SI-S) and long (SI-L) forms of the Symptom Inventory in persons with MS. Methods The sample included 133 individuals with MS who completed the SI-L, Performance Scales (PS), EDSS, Multiple Sclerosis Walking Scale-12 (MSWS-12), Multiple Sclerosis Impact Scale-29 (MSIS-29), and Godin Leisure-Time Exercise Questionnaire (GLTEQ) and then wore an accelerometer for 7 days. The data were analyzed using SPSS, version 16.0. Results There were large correlations between SI-S and SI-L total and subscale scores and between SI-S, SI-L, and PS total scores. The correlations were similar in magnitude between SI-S, SI-L, and PS scores with EDSS and MSIS-29 scores, but not with MSWS-12, accelerometer, and GLTEQ scores. Discriminant function analysis indicated that SI-S scores better differentiated groups with minimal, moderate, and severe disability than did SI-L and PS scores. Regression analysis indicated that SI-S and SI-L scores explained incrementally more variance in EDSS, MSWS-12, and MSIS-29 scores after accounting for PS scores alone. Conclusion Such findings provide additional support for the validity of both SI-S and SI-L scores in individuals with MS and support the adoption of either the SI-S or SI-L by clinical MS researchers.

Confirmation and extension of the validity of the Multiple Sclerosis Walking Scale-12 (MSWS-12)

The Multiple Sclerosis Walking Scale-12 (MSWS-12) is a 12-item patient-rated measure of the impact of MS on walking. As validation of scores from a measure is an ongoing and evolving process, the provision of additional evidence is warranted that confirms and extends the validity of inferences from scores on the MSWS-12. Participants (N=133) were recruited through support group meetings of the Greater Illinois and Indiana State Chapters of the National Multiple Sclerosis Society, and wore an accelerometer for a seven-day period and completed the MSWS-12 and other outcome measures. Confirmatory factor analysis indicated that a single-factor model provided an adequate fit for MSWS-12 scores. MSWS-12 scores demonstrated strong evidence of internal consistency. The correlations between MSWS-12 scores with scores from other scales, including an accelerometer, were consistent with our a priori hypotheses. We provide evidence that both confirms and extends the validity of inferences from scores of the MSWS-12 as a measure of the impact of MS on walking in a community-based sample of individuals with MS.