Timed 25-Foot Research Articles

Google Maps Timeline: An open-access digital tool to monitor walking abilities in people with multiple sclerosis.

Gait impairment is common in multiple sclerosis (MS), but difficult to evaluate in clinical practice. In this proof-of-concept observational study, we compared walking ability recorded by Google Maps Timeline to conventional clinical measures in people with MS. We used open-access Google Maps Timeline to record the total number of days with walking activity, walking distance, walking time, and walking speed. Each Google Maps Timeline variable was included in a different stepwise linear regression model including all conventional clinical variables. We included nine people with MS (age 43.1 ± 6.6 years; females 55.6%; disease duration 12.7 ± 3.1 years; median Expanded Disability Status Scale 3.0 (range 1.0-5.5)). Higher percentage of days with recorded walking was associated with lower Fatigue Severity Scale (p = 0.01), and higher MS Walking Scale (p = 0.04). Longer average daily walking distance was associated with shorter Timed-25 Foot Walking Test (p = 0.02), lower Expanded Disability Status Scale (p = 0.01), and higher Euro-Quality of Life (p = 0.04). Longer average daily walking time was associated with shorter Timed-25 Foot Walking Test (p = 0.03). Higher walking speed was associated with lower Fatigue Severity Scale (p = 0.04). Google Maps Timeline parameters provide actual estimates of daily walking activities in MS.

A Novel Functional Electrical Stimulation Device Plus Telerehabilitation Improves Walking in People with Multiple Sclerosis: A Case Series

Background and purpose Foot drop in people with multiple sclerosis (PwMS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve gait but access to wearable FES devices is limited by cost and burden of in-person visits for device optimization. Therefore, the purpose of this case series was to assess the effectiveness and feasibility of a telehealth-monitored FES device. Methods Ten PwMS (50.2 years [SD 11.3]; 2 males) with moderate disability (median EDSS 4.75; IQR 3.75 – 5.75) were provided an EvoWalk FES device. Participants were prescribed an 8-week wear-schedule. A wearable accelerometer (ActiGraph) recorded daily step count at week 0 and 8. For week 0 activity levels, the EvoWalk was donned but not activated, and settings were progressed over three bi-weekly telehealth sessions. Effectiveness was assessed by Timed-25 Foot Walk (T25FW), 2-Minute Walk test (2MWT), Timed-Up and Go (TUG), and self-report of walking, fatigue, and QOL collected in-person at baseline and study end. Feasibility was assessed by percentage of telehealth visits completed and participant-reported satisfaction. Results All (100%) telehealth visits were completed with high levels of satisfaction reported, mean score 4.7/5 (SD .51). ActiGraph data were available for 3 participants: average daily step count pre (2,996; SD 1,235) was lower than post (3,930: SD 1,157) EvoWalk use. At study completion, use of FES resulted in a larger orthotic effect in gait speed for T25FW (-14.2%), TUG (-17.0%) and distance on the 2MWT (14.6%). Post-trial self-report measures showed improvements in subjective walking (-15.6%), QOL (-13.6%) and fatigue (-7.5%). Discussion Telehealth was safe and feasible for progressing FES intervention. Gait speed, walking distance, and QOL improved following the intervention. Using telerehabilitation to monitor FES intervention may simultaneously improve access and reduce patient burden. Future research should include follow-up to assess long-term effects Foot drop in people with multiple sclerosis (PwMS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve gait but access to wearable FES devices is limited by cost and burden of in-person visits for device optimization. Therefore, the purpose of this case series was to assess the effectiveness and feasibility of a telehealth-monitored FES device. Ten PwMS (50.2 years [SD 11.3]; 2 males) with moderate disability (median EDSS 4.75; IQR 3.75 – 5.75) were provided an EvoWalk FES device. Participants were prescribed an 8-week wear-schedule. A wearable accelerometer (ActiGraph) recorded daily step count at week 0 and 8. For week 0 activity levels, the EvoWalk was donned but not activated, and settings were progressed over three bi-weekly telehealth sessions. Effectiveness was assessed by Timed-25 Foot Walk (T25FW), 2-Minute Walk test (2MWT), Timed-Up and Go (TUG), and self-report of walking, fatigue, and QOL collected in-person at baseline and study end. Feasibility was assessed by percentage of telehealth visits completed and participant-reported satisfaction. All (100%) telehealth visits were completed with high levels of satisfaction reported, mean score 4.7/5 (SD .51). ActiGraph data were available for 3 participants: average daily step count pre (2,996; SD 1,235) was lower than post (3,930: SD 1,157) EvoWalk use. At study completion, use of FES resulted in a larger orthotic effect in gait speed for T25FW (-14.2%), TUG (-17.0%) and distance on the 2MWT (14.6%). Post-trial self-report measures showed improvements in subjective walking (-15.6%), QOL (-13.6%) and fatigue (-7.5%). Telehealth was safe and feasible for progressing FES intervention. Gait speed, walking distance, and QOL improved following the intervention. Using telerehabilitation to monitor FES intervention may simultaneously improve access and reduce patient burden. Future research should include follow-up to assess long-term effects

Making Every Step Count: Minute-by-Minute Characterization of Step Counts Augments Remote Activity Monitoring in People With Multiple Sclerosis.

BackgroundAmbulatory disability is common in people with multiple sclerosis (MS). Remote monitoring using average daily step count (STEPS) can assess physical activity (activity) and disability in MS. STEPS correlates with conventional metrics such as the expanded disability status scale (Expanded Disability Status Scale; EDSS), Timed-25 Foot walk (T25FW) and timed up and go (TUG). However, while STEPS as a summative measure characterizes the number of steps taken over a day, it does not reflect variability and intensity of activity.ObjectivesNovel analytical methods were developed to describe how individuals spends time in various activity levels (e.g., continuous low versus short bouts of high) and the proportion of time spent at each activity level.Methods94 people with MS spanning the range of ambulatory impairment (unaffected to requiring bilateral assistance) were recruited into FITriMS study and asked to wear a Fitbit continuously for 1-year. Parametric distributions were fit to minute-by-minute step data. Adjusted R2 values for regressions between distributional fit parameters and STEPS with EDSS, TUG, T25FW and the patient-reported 12-item MS Walking scale (MSWS-12) were calculated over the first 4-weeks, adjusting for sex, age and disease duration.ResultsDistributional fits determined that the best statistically-valid model across all subjects was a 3-compartment Gaussian Mixture Model (GMM) that characterizes the step behavior within 3 levels of activity: high, moderate and low. The correlation of GMM parameters for baseline step count measures with clinical assessments was improved when compared with STEPS (adjusted R2 values GMM vs. STEPS: TUG: 0.536 vs. 0.419, T25FW: 0.489 vs. 0.402, MSWS-12: 0.383 vs. 0.378, EDSS: 0.557 vs. 0.465). The GMM correlated more strongly (Kruskal-Wallis: p = 0.0001) than STEPS and gave further information not included in STEPS.ConclusionsIndividuals' step distributions follow a 3-compartment GMM that better correlates with clinic-based performance measures compared with STEPS. These data support the existence of high-moderate-low levels of activity. GMM provides an interpretable framework to better understand the association between different levels of activity and clinical metrics and allows further analysis of walking behavior that takes step distribution and proportion of time at three levels of intensity into account.

Cross-sectional and longitudinal correlations between the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and other outcome measures in multiple sclerosis

BackgroundThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) is the first validated disease specific patient-reported outcome measure (PROM) designed to assess upper extremity function in patients with multiple sclerosis (MS). ObjectiveTo determine correlations between the AMSQ and established physician- and performance based outcome measures. MethodsIn a cross-sectional cohort of 533 patients correlations between the AMSQ and the Expanded Disability Status Scale (EDSS), its functional systems, the 9-Hole Peg Test (9-HPT) and the Timed-25 Foot Walk (T25FW) were determined. Subgroup analyses were performed as well. Also, correlations were determined in 110 of 533 patients with available longitudinal data. ResultsStrongest correlations were found in the cross-sectional cohort between the AMSQ and the EDSS (β 0.60, p<.001), the 9-HPT dominant hand (β 0.52, p<.001) and 9-HPT non-dominant hand (β 0.46, p<.001), the Pyramidal (β 0.57 p<.001) and the Cerebellar functional system (β 0.54, p<.001) of the EDSS. ConclusionThe moderate correlations between the AMSQ and several established physician- and performance based outcome measures underline that the AMSQ, an easily at long-distance administrable PROM, could be considered as a reliable outcome measure for the monitoring of MS in daily practice. Additional research is needed to support these findings.

The Expanded Disability Status Scale scoring in patients with multiple sclerosis

Gait disturbance is a major symptom in patients with multiple sclerosis. The Expanded Disability Status Scale (EDSS) was first used in clinical trials of multiple sclerosis for the assessment of disability, however it has become more and more widely used in clinical practice as well. Nowadays its use is essential in application of the new diagnostic criteria, the new clinical form classification and in monitoring the efficacy of therapies. EDSS is based on a standardised neurological examination, but focuses on those symptoms that are frequent in multiple sclerosis. Based on the examination it assesses seven functional systems: visual, brainstem, pyramidal, cerebellar, sensory, bowel-bladder and cerebral functions. EDSS scores can be determined based on the scores given in the functional systems and on testing the walking distance. In newer versions the "Ambulation score" has been added. This chapter clarifies the scores based on the maximal walking distance and the need for a walking aid to walk this distance. The Neurostatus/EDSS training method improves the reproducibility of the standardised neurological examination that forms the basis of the EDSS scoring. Of the tests assessing walking, the Timed-25 Foot Walk Test and the self-administered 12-Item Multiple Sclerosis Walking Scale are suitable for routine evaluation of walking performance. An increase of more than 20% in the Timed-25 Foot Walk may be considered a significant change in gait.

Tasks of activities of daily living (ADL) are more valuable than the classical neurological examination to assess upper extremity function and mobility in multiple sclerosis

Background: Accurate clinical assessment in multiple sclerosis (MS) is challenging. The Assess MS system is being developed to automatically quantify motor dysfunction in MS, including upper extremity function (UEF) and mobility. Objective: To determine to what extent combinations of standardized movements included in the Assess MS system explain accepted measures of UEF and mobility. Methods: MS patients were recruited at four European MS centres. Eight movements were selected, including tasks of activities of daily living (ADL) and classical neurological tests. Movements were recorded on video and rated by experienced neurologists (n = 5). Subsequently, multivariate linear regression models were performed to explain the variance of the Nine-Hole Peg Test (9HPT), Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and Timed-25 Foot Walk test (T25WT). Results: In total, 257 patients were included. The movements explained 62.9% to 80.1% of the variance of the 9HPT models, 43.3% and 44.3% of the AMSQ models and 70.8% of the T25WT. In all models, tasks of ADL contributed most to the variance. Conclusion: Combinations of movements are valuable to assess UEF and mobility. Incorporating ADL tasks into daily clinical practice and clinical trials may be more valuable than the classical neurological examination of UEF and mobility.

Contributions of Ankle, Knee, Hip, and Trunk Muscle Function to Gait Performance in People With Multiple Sclerosis: A Cross-Sectional Analysis.

The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. This was a cross-sectional, observational study. Participants were people who had an Expanded Disability Status Scale score of≤5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD=1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI=-0.71 to-0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance.

Magnetic resonance imaging correlates of clinical outcomes in early multiple sclerosis

ObjectivesTo study the association between changes in brain magnetic resonance imaging (MRI) and clinical outcomes in early MS. MethodsMS patients within 12 months of onset were enrolled and followed up to 3 years. Clinical measures included Symbol Digit Modalities Test (SDMT), MS Functional Composite (MSFC) and low contrast letter acuity (LCLA). MRI outcomes included brain volume changes measured by SIENA and SIENAX normalized measurements [brain parenchymal volume (BPV), normal-appearing white and gray matter volume (NAWMV and GMV) and T2 lesion volume (T2LV)]. Mixed model regression measured time trends and associations between imaging and clinical outcome. ResultsForty-three patients were enrolled within 7.5±4.9 months of onset. Baseline T2 lesion volume predicted subsequent changes in Paced Auditory Serial Addition Test (PASAT) (p=0.004), whereas baseline measures of atrophy including BPV, GMV, and NAWMV predicted longitudinal changes in MSFC (p=0.016, p=0.040, p=0.021, respectively) and Timed-25 Foot Walk (p<0.05). Each 1% decrease in SIENA was associated with 1.14 point decrease in SDMT score (p=0.03). Each 1% decrease in brain volume SIENA was associated with almost 1.5 letters decrease on LCLA (p=0.02). ConclusionMeasures of lesion volume and overall brain volume were associated with different long-term clinical outcome measures in early MS.

A corrected version of the Timed-25 Foot Walk Test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients

No clinical test is currently available and validated to measure the maximum walking speed (WS) of multiple sclerosis (MS) patients. Since the Timed 25-Foot Walk Test (T25FW) is performed with a static start, it takes a significant proportion of the distance for MS patients to reach their maximum pace. In order to capture the maximum WS and to quantify the relative impact of the accelerating phase during the first meters, we compared the classical T25FW with a modified version (T25FW(+)allowing a dynamic start after a 3 meters run-up. Sixty-four MS patients and 30 healthy subjects performed successively the T25FW and the T25FW(+). The T25FW(+)was performed faster than the T25FW for the vast majority of MS and healthy subjects. In the MS population, the mean relative gain of speed due to the dynamic start on T25FW(+) was independent from the EDSS and from the level of ambulation impairment. Compared to healthy subjects, the relative difference between dynamic versus static start was more important in the MS population even in patients devoid of apparent gait impairment according to the T25FW. The T25FW(+)allows a more accurate measurement of the maximum WS of MS patients, which is a prerequisite to reliably evaluate deceleration over longer distance tests. Indirect arguments suggest that the time to reach the maximum WS may be partially influenced by the cognitive impairment status. The maximum WS and the capacity of MS patients to accelerate on a specific distance may be independently regulated and assessed separately in clinical trials and rehabilitation programs.

Functional Effect of an Ankle Foot Orthosis on Gait in Multiple Sclerosis

The objective was to determine whether an ankle foot orthosis improves gait velocity and tasks of functional ambulation in multiple sclerosis (MS). This cross-sectional study enrolled 15 participants with diagnosis of MS, dorsiflexion and eversion weakness, and more than 3 mos of using a physician-prescribed ankle foot orthosis (AFO). Subject ambulation was evaluated (1) without an AFO and (2) with an AFO. Outcome measures were the Timed 25-Foot (T25-FW) Walk portion of the Multiple Sclerosis Functional Composite (MSFC) and the five trials (Floor, Carpet, Up and Go, Obstacles, Stairs) of the Modified Emory Functional Ambulation Profile (mEFAP). The mean timed differences on the T25-FW and the five components of the mEFAP between the AFO vs. no device trials were not statistically significant. In MS subjects with dorsiflexion and eversion weakness, no statistically significant improvement was found performing timed tasks of functional ambulation with an AFO.