Long walking tests and patient-reported MSWS-12 were more appropriate than short walking tests in detecting clinically meaningful improvement after physical rehabilitation, particularly the MSWS-12 for moderate to severely disabled pwMS.

ObjectiveTo determine responsiveness of functional mobility measures, and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS) in response to physical rehabilitation.MethodsThirteen mobility measures (clinician- and patient-reported) were assessed before and after rehabilitation in 191 pwMS from 17 international centers (European and United States). Combined anchor- and distribution-based methods were used. A global rating of change scale, from patients' and therapists' perspective, served as external criteria when determining the area under the receiver operating characteristic curve (AUC), the minimally important change (MIC), and the smallest real change (SRC). Patients were stratified into 2 subgroups based on disability level (Expanded Disability Status Scale score ≤4 [n = 72], >4 [n = 119]).ResultsThe Multiple Sclerosis Walking Scale–12, physical subscale of the Multiple Sclerosis Impact Scale–29 (especially for the mildly disabled pwMS), Rivermead Mobility Index, and 5-repetition sit-to-stand test (especially for the moderately to severely disabled pwMS) were the most sensitive measures in detecting improvements in mobility. Findings were determined once the AUC (95% confidence interval) was above 0.5, MIC was greater than SRC, and results were comparable from the patient and therapist perspective.ConclusionsResponsiveness, clinically meaningful improvement, and real changes of frequently used mobility measures were calculated, showing great heterogeneity, and were dependent on disability level in pwMS.

The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.

Avoidant coping style, female gender, and longer disease duration were associated with shorter time to unemployment. These factors should be considered when advising patients on MS and future employment.

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients with stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test-retest reliability. Method:The TIS was translated according to international guidelines. 201 patients with acute stroke were recruited for the validity study, and 50 inpatients with acquired brain lesions were recruited for the study of intertester and test-retest reliability.Construct validity was analysed using explorative factor analysis, confirmatory factor analysis and item response theory, internal consistency with Cronbach's alpha test, and intertester and test-retest reliability with kappa and intraclass correlation coefficient tests. Results:The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed from the test. Six testlets were hierarchically constructed by combining items from the subscales Dynamic sitting balance and Coordination, and renamed modified TIS-NV (TIS-modNV). After these modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. The test demonstrated good construct validity, excellent internal consistency, as well as high intertester and test-retest reliability for the total score. Conclusions:The TIS-modNV is a valid and reliable scale for use in clinical practice and research.3 Main textPatients with disability due to neurological lesions constitute one of the greatest challenges for society and health services in developed countries [1]. The most common cause of brain damage in adults is stroke, and in Norway approximately 15.000 persons suffer a stroke each year [2]. Rehabilitation should be beneficial for the individual patient as well as for society [3], and adequate assessment tools are needed to examine relevant functional aspects.Impaired balance is a common physical deficit post stroke [4;5], and improved balance has been found to be associated with improved rehabilitation outcomes [6], ability to perform daily activities [7], and walking [8]. Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].The trunk seems particularly important for balance as it stabilizes the pelvis and spinal column [11], being a prerequisite for coordinated use of the extremities in functional activities such as reaching and gait [12]. Impaired trunk control seems common post stroke [13], and trunk control assessed in patients early after stroke has been found predictive of long-term functional improvement [14;15] Even if previous studies using CTT have given important psychometric information, there are several problems with the assumptions underlying CTT such as sample dependency, item equivalence and standard error of measurement [25]. If the data can meet certain rather strict assumptions, Item Response Theory (IRT) overcomes many of these limitations [26;27]. IRT also provides rather sophisticated psyc...

ObjectiveTo compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control).DesignGroup comparison study within a randomised controlled trial.SettingHospital stroke unit and primary healthcare.ParticipantsInclusion criteria: a score of 2–26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit.InterventionsTwo intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment.Outcome measuresPrimary: PASS. Secondary: Trunk Impairment Scale—modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion.ResultsFrom a total of 306 randomised patients, 167 were tested with PASS at baseline and discharged directly home. 105 were retested at 3 months: mean age 69 years, 63 men, 27 patients in day unit rehabilitation, 43 in home rehabilitation and 35 in a control group. There were no group differences, either at baseline for demographic and test data or for length of stroke unit stay. At 3 months, there was no group difference in change on PASS (p>0.05). Some secondary measures tended to show better outcome for the intervention groups, that is, trunk control, median (95% CI): day unit, 2 (0.28 to 2.31); home rehabilitation, 4 (1.80 to 3.78); control, 1 (0.56 to 2.53), p=0.044; and for self-report on walking, p=0.021 and ADL, p=0.016.ConclusionsThere was no difference in change between the groups for postural balance, but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group.Trial registrationThis study is part of the Early Supported Discharge after Stroke in Bergen, ClinicalTrials.gov (NCT00771771).

To our knowledge this is the first study that has explored this topic in MS. The results broaden our understanding of the different PT interventions used in MS, as well as the context of their use.

Participating in inpatient rehabilitation gave people with MS the possibility to exchange information and communicate strategies for coping with the disease-related conditions and societal demands. They established social relations recognizing each other's resources. Participants felt equipped to make decisions and to mobilize individual and collective resources. Recognition of the individual with both ability and impairment can be a key to empowerment. Implications for Rehabilitation In multiple sclerosis (MS), the clinical symptoms and the unpredictability of the disease may have consequences for how patients relate to self and to others, and hence how they perform socially. Stigmatization is commonly experienced among people with MS. The recognition experienced from peers create a sense of community. We recommend health care professionals to acknowledge the importance of peer support for self, identity and empowerment in MS.