Development of a gait module to complement the 12-item Multiple Sclerosis Walking Scale: a mixed methods study

Strzok, Sara; Cleanthous, Sophie; Pompilus, Farrah; Cano, Stefan; Marquis, Patrick; Cohan, Stanley; Goldman, Myla D.; Kresa-Reahl, Kiren; Petrillo, Jennifer; Castrillo‐Viguera, Carmen; Cadavid, Diego; Chen, Shih‐Yin

doi:10.1177/2055217318783766

Cited by 4 publications

(7 citation statements)

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“…Hobart and Cano 32 have previously described that rating scales, developed based on classical test theory criteria, may be expected to have a more narrow spectrum than a person's ability represent. Therefore, in recent studies of the Rasch model analysis the measurement spectrum of Walk‐12 has been extended by adding gait items in order to improve sensitivity and to detect clinical change in walking ability for higher functioning patients with MS 13 . That other gait parameters could also be used in addition to Walk‐12 is in line with our previous studies in persons with LEoP and stroke 3,16 .…”

Section: Discussionmentioning

confidence: 62%

“…In addition, the Walk‐12 has been shown to be valid or moderately associated to other measures of physical function, 8,11,12,17 lower limb function, and social participation 14 . It has also been shown to be partly related to objective gait performance tests measuring walking speed, cadence, or walking distance 3,11,13,14,16,17 …”

Section: Discussionmentioning

confidence: 99%

“…One rating scale that can be used to assess self‐perceived walking limitations in everyday life is the 12‐item Walking Impact Scale (Walk‐12), 11 which is based on the Multiple Sclerosis Walking Scale (MSWS‐12) 12 . From a large item set of 141 items describing the impact of MS on health, 12 items were intended to assess different aspects of walking 12,13 . Even though the scale was originally developed for people with MS, the Walk‐12 has been used in various neurological conditions 11,12,14–17 as well as in persons with LEoP 3,18 .…”

Section: Introductionmentioning

confidence: 99%

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Psychometric Properties of the Walking Impact Scale (Walk‐12) in Persons with Late Effects of Polio

Brogårdh

Lexell

Westergren

2020

PM&R

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Background Many persons with late effects of polio (LEoP) perceive walking limitations in everyday life. A common rating scale to assess walking limitations is the Walking Impact Scale (Walk‐12). However, there is limited knowledge about its psychometric properties. Objective To investigate the psychometric properties of Walk‐12 in persons with LEoP. Design Rasch model analysis of cross‐sectional data. Setting University hospital. Participants A total of 325 persons with LEoP (175 women; mean age 70 ± 10 years). Main Outcome Measurement The Walk‐12, comprising 12 items with five response categories ranging from 1 (not at all) to 5 (extremely). Methods Data of Walk‐12 were collected by a postal survey. The Rasch model analysis was used to analyze unidimensionality of the scale, local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning, and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. Results The analysis revealed that Walk‐12 was multidimensional and suffered from some local dependency. Targeting was compromised among persons with less and more walking limitations. Hierarchically, the most difficult item to perform was “running” and the easiest was “walking indoors with support”. There was a minor DIF for gender in one item (“support when walking outdoors”). Reliability was high (PSI = 0.94). Disordered response category thresholds were found for three items; when merging the middle response categories for these items model fit slightly improved and unidimensionality was achieved. Conclusions The Walk‐12, in its current version, does not fully meet the rigorous psychometric Rasch measurement standards in persons with LEoP. Further development of the scale is warranted, including merging response categories and complementing Walk‐12 with objective measures of gait in order to improve targeting. As these limitations can be considered minor, the current version of Walk‐12 can still be useful for research and clinical practice.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Psychometric Properties of the Walking Impact Scale (Walk‐12) in Persons with Late Effects of Polio

Brogårdh

Lexell

Westergren

2020

PM&R

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“…The items could also be used jointly with the MSIS-29, providing wider coverage of the impact of MS over different stages of the disease if a broader population is considered. Such a "bolt-on" strategy was recently applied to address similar issues in other PRO instruments used in MS. 25,26 Despite the superiority of ofatumumab over teriflunomide on reducing the risk of relapses and disability progression in ASCLEPIOS I/II-outcomes which directly affect quality of life-the MSIS-29 did not demonstrate a clinically meaningful difference between the treatment arms. Demonstration of a treatment benefit in this context requires instruments able to detect subtle changes in the experience of patients whose functional status is minimally impaired.…”

Section: Discussionmentioning

confidence: 98%

Does the Multiple Sclerosis Impact Scale-29 (MSIS-29) have the range to capture the experience of fully ambulatory multiple sclerosis patients? Learnings from the ASCLEPIOS studies

Regnault,

Loubert,

Brennan

et al. 2023

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Trials of disease-modifying therapies (DMTs) for multiple sclerosis (MS) often include patients with minimal disability. Patient-reported outcome instruments used in these trials have often not captured physical and psychological treatment effects concomitant with observed clinical benefits. Objective To examine whether the Multiple Sclerosis Impact Scale-29 (MSIS-29) captures changes in the impact of MS in a sample of patients enrolled in the Phase 3 ASCLEPIOS studies (ofatumumab vs. teriflunomide). Methods Measurement properties (i.e. item fit, reliability, and targeting) of the MSIS-29 were analyzed using Rasch measurement theory (RMT) in data from two phase 3 ofatumumab clinical trials including patients with relapsing-remitting or secondary progressive MS ( N = 1882). Targeting of the MSIS-29 items to the patient population was explored within groups categorized by Expanded Disability Status Scale (EDSS) scores. Results Under RMT analyses, both the Physical and Psychological Impact scales of the MSIS-29 were not appropriately targeted to the overall sample of patients. In particular, 49% and 30% of patients with an EDSS score ≤ 2.5 had fewer physical and psychological impacts, respectively, than would typically be captured by these MSIS-29 items compared to patients with EDSS scores of ≥ 3. Conclusion The MSIS-29 is commonly used to evaluate the patient-reported physical and psychological impact of MS. However, it may be limited in evaluating changes associated with DMTs in patients with minimal disability.

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“…Mixed methods research (MMR) can be defined as "research in which the investigator collects and analyzes data, integrates the findings, and draws inferences using both qualitative and quantitative approaches or methods in a single study or program of inquiry" [16]. MMR has been increasingly used in health outcomes research over the past years for different purposes [17]: for example, to explore the benefit-risk balance from the patient perspective in rare diseases [18]; to generate information to support the interpretation of patient-reported outcome (PRO) scores [19,20]; to capture the patient's and family's voice in natural history studies for orphan drug development [21]; or to create fit-for-purpose PRO measures [22,23]. Besides, MMR is recognized as a useful method to generate patient-centered evidence by regulatory agencies [24].…”

Section: Introductionmentioning

confidence: 99%

Applying a mixed methods design to test saturation for qualitative data in health outcomes research

2020

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Saturation, a core concept in qualitative research, suggests when data collection might end. It is reached when no new relevant information emerges with additional interviews. The aim of this research was to explore whether a mixed methods design could contribute to the demonstration of saturation. Firstly, saturation was conceptualized mathematically using set theory. Secondly, a conversion mixed design was conducted: a set of codes derived from qualitative interviews were quantitized and analyzed using partial least squares (PLS) regression to document whether saturation was reached. A qualitative study conducted by other researchers prior to this work (i.e. none of the present authors was involved in this study) was used to test saturation using PLS regression. This illustrative qualitative study aimed to investigate the impact of Clostridium difficile infection (CDI) on nurses' work in the hospital and the results were published elsewhere (Guillemin et al. 2015). Semi-structured interviews were conducted with 12 nurses. Saturation was characterized by the cumulative percentage of variability accounted for by PLS factors. After 12 interviews, this percentage was 51% which suggests that saturation was achieved at least on main themes. Two main themes identifying similarities in the experience of nurses caring for patients with CDI were identified: Organization/Coordination of the working day and Time-consuming work. Although dependent on the coding of qualitative data, PLS regression of quantitized data from qualitative interviews generated useful information for the determination of saturation.

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Development of a gait module to complement the 12-item Multiple Sclerosis Walking Scale: a mixed methods study

Cited by 4 publications

References 23 publications

Psychometric Properties of the Walking Impact Scale (Walk‐12) in Persons with Late Effects of Polio

Psychometric Properties of the Walking Impact Scale (Walk‐12) in Persons with Late Effects of Polio

Does the Multiple Sclerosis Impact Scale-29 (MSIS-29) have the range to capture the experience of fully ambulatory multiple sclerosis patients? Learnings from the ASCLEPIOS studies

Applying a mixed methods design to test saturation for qualitative data in health outcomes research

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