The measurement of ambulatory impairment in multiple sclerosis

Schwid, Steven R.; Goodman, Andrew; Mattson, David H.; Mihai, Cornelia; DONOHOE, KATHARINE M.; Petrie, Mary; Scheid, Eileen; Dudman, Jessica; McDermott, Michael P.

doi:10.1212/wnl.49.5.1419

Cited by 98 publications

(68 citation statements)

References 5 publications

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“…15 A high correlation for the speed used on an 8-m walkway and the maximum distance walked for up to 500 m (r = .79, P < .0001) was found in patients with multiple sclerosis. 16 In another study, the interrater reliability of the 6-minute walking distance and the 10-m walking time in 62 patients with SCI (most graded ASIA D) also found a significant correlation between the 2 measures. 17 The mean 10-m walking speed was 0.33 ± 0.36 m/s, and the 6-minute speed was 0.56 ± 0.3 m/s.…”

Section: Discussionmentioning

confidence: 90%

Comparison of Speeds Used for the 15.2-Meter and 6-Minute Walks Over the Year After an Incomplete Spinal Cord Injury: The SCILT Trial

Barbeau

Elashoff²,

Deforge

et al. 2007

Neurorehabil Neural Repair

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Background. Timed walking speed for 6 to 15 m and the distance walked in 2 to 12 minutes are frequently used outcome measures in rehabilitation trials, presumably reflecting different aspects of walking ability. The database from the Spinal Cord Injury Locomotor Trial (SCILT), which tested 2 interventions for mobility upon admission for initial rehabilitation of an incomplete traumatic spinal cord injury (SCI), was used to compare the walking speed employed for each test. Methods. From 66 to 70 patients with upper motor neuron lesions from C-5 to T-10 performed a 15.2-m and a 6-minute walk as fast as the patient deemed safe at 3 months (end of the trial intervention) and 6 and 12 months after entry. The means, standard errors, and quartiles were calculated for the speed used for each task. Results. The mean speed for the 15.2-m walk did not differ from that used for the 6-minute walk at 3 and 6 months but was significantly faster at 12 months. Differences became apparent at each assessment in patients in the highest quartiles (>1.0 m/s) for the 15.2-m walk. Their speed was from 14% to 24% higher than the speed used for the 6-minute walk. Conclusion. The speed of the 15.2-m walk as a measure of walking ability compared to the distance walked in 6 minutes may not represent separable domains of mobility. Differences were apparent only in the most highly functional patients, who could ambulate in the community. Any difference in the walk-

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Section: Discussionmentioning

confidence: 90%

Comparison of Speeds Used for the 15.2-Meter and 6-Minute Walks Over the Year After an Incomplete Spinal Cord Injury: The SCILT Trial

Barbeau

Elashoff²,

Deforge

et al. 2007

Neurorehabil Neural Repair

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“…The T25W [9, 10], the 9-HPT [11]and the PASAT (3-min version) [12]were administered as described previously [13]. …”

Section: Methodsmentioning

confidence: 99%

Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator

Kotterba¹,

Orth²,

Eren³

et al. 2003

Eur Neurol

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Objective: To compare the driving performance using a driving simulator with physical and cognitive functions as measured by the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients suffering from the relapsing-remitting form of multiple sclerosis (RRMS). Methods: 31 RRMS patients (18 women, 13 men, mean age 35.6 ± 8.3 years, EDSS 2.8 ± 1.4) were compared with 10 healthy controls (8 men, 2 woman, age 45.1 ± 7.8 years). Results: Compared with controls, the accident rate (5.3 ± 3.8 vs. 1.3 ± 1.5, p < 0.001) and concentration faults (21.1 ± 15.5 vs. 7.1 ± 2.6, p < 0.01) of RRMS patients using the driving simulator were increased. While there was no correlation with the EDSS score, the accident rate was correlated with the MSFC (r = –0.5, p < 0.05). Regarding the three dimensions of the MSFC, accidents were related to the number of correct answers and Z-score in the paced auditory serial addition test (PASAT) as a measure for cognitive function (r = –0.33, p < 0.05). Conclusion: The current study demonstrates the need to focus also on driving skills in MS patients. The risk of accidents should be evaluated after relapses in particular. However, there are great interindividual differences. In the MSFC, most deficits could be evaluated in the PASAT. As there was a significant correlation between the accident rate in the driving simulator and the PASAT results, accidents seem to be more influenced by cognitive decline than by physical impairment. This indicates that the MSFC is a broader, more dimensional scale than the EDSS and should be preferred in the case of driving assessment. At the present time, the driving simulator seems to be a useful instrument judging driving ability, especially in cases with ambiguous neuropsychological results.

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“…A measure often used in clinical trials where the experimental therapy may improve walking ability is the 25-foot walk (T25FW) 15 time, which seems to have face validity as an outcome in that it is a direct assessment of the construct under investigation. Yet, even in this case, it can be questioned whether a particular change in speed is relevant.…”

Section: Quantitative Interpretability and Clinically Meaningful Changementioning

confidence: 99%

Evaluating cognitive outcome measures for MS clinical trials: what is a clinically meaningful change?

Benedict

Walton

2012

Mult Scler

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Brief cognitive assessments are increasingly emphasized in MS treatment studies and clinical care. While much is known about the reliability of several widely-used neuropsychological tests, interpretation of the changes in individual patients is inadequate. The FDA offers guidance on the issue, as related to patient-reported outcomes. Unfortunately, cognitive ability is only weakly correlated with the frequency and severity of self-reported cognitive problems. In this review, we critically examined the psychometrics of neuropsychological testing in MS, emphasizing statistical and anchor-based approaches to interpreting clinically meaningful change. We suggest that there are two paths forward that should be currently pursued. First, to employ co-primary outcomes, including a brief cognitive test and a clinician or observer’s impression on a scale of change, where successful treatment would require showing significant improvement in both measures. Secondly, to work toward showing that when reliable brief cognitive tests are employed, increments of statistically-relevant change would correlate with changes in clinically-relevant anchors (such as vocational disability or clinical relapses with cognitive impairment). The latter goal will allow a more parsimonious and scientifically efficient approach of utilizing only the brief cognitive test as a primary outcome. While some progress has been made in this direction, more research is needed. We are of the opinion that data from both the statistical and clinically meaningful approaches will be necessary to develop valid definitions of meaningful change on cognitive outcome measures, and that it would be best to pursue research using tests that already have well-established reliability and validity.

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The measurement of ambulatory impairment in multiple sclerosis

Cited by 98 publications

References 5 publications

Comparison of Speeds Used for the 15.2-Meter and 6-Minute Walks Over the Year After an Incomplete Spinal Cord Injury: The SCILT Trial

Comparison of Speeds Used for the 15.2-Meter and 6-Minute Walks Over the Year After an Incomplete Spinal Cord Injury: The SCILT Trial

Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator

Evaluating cognitive outcome measures for MS clinical trials: what is a clinically meaningful change?

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