TY - JOUR
T1 - Variability of objective gait measures across the expanded disability status scale in people living with multiple sclerosis
T2 - A cross-sectional retrospective analysis
AU - Zanotto, Tobia
AU - Sosnoff, Jacob J.
AU - Ofori, Edward
AU - Golan, Daniel
AU - Zarif, Myassar
AU - Bumstead, Barbara
AU - Buhse, Marijean
AU - Kaczmarek, Olivia
AU - Wilken, Jeffrey
AU - Muratori, Lisa
AU - Covey, Thomas J.
AU - Gudesblatt, Mark
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/3
Y1 - 2022/3
N2 - Background: The Expanded Disability Status Scale (EDSS) is widely utilized in clinical trials and routine care to evaluate disease burden and progression among people with multiple sclerosis (pwMS). However, instrumental gait measures may be more suitable than EDSS to track walking disability in pwMS. In this cross-sectional study, we aimed to quantify the variability of spatiotemporal gait measures within homologous EDSS categories. Methods: A total of 205 pwMS (age=46.5[SD=10.5] years, 72.2% female, EDSS range=1.0–6.5) were studied in this retrospective analysis. Participants underwent walking assessments through the GAITRite system and the following spatiotemporal gait measures were recorded: gait speed, mean normalized velocity (MNV), base of support, stride length, step length, percentage of gait cycle spent in double support and single support, and functional ambulation profile. The EDSS was evaluated by a certified neurologist. Results: All gait measures exhibited fair to very strong correlations with scores on the EDSS (-0.81≤ρs≤0.25) and poor to fair correlations with disease duration (-0.32≤ρs≤0.17). Overall, the percent variability of gait measures increased across EDSS categories, with coefficients of variation ranging from 6.9% to 37.2% in the minimal disability group (EDSS≤2.5), 8.1% to 33.4% and 22.3% to 53.8% in the moderate (2.54.5) disability groups, respectively. Conclusion: Spatiotemporal gait measures have great variability within homologous EDSS categories. The high percent variability of gait speed and MNV (up to more than 50%) suggests that walking ability varies substantially within and across disability levels. Therefore, in addition to the EDSS, more comprehensive (multidimensional), objective patient-centric metrics would be needed to accurately evaluate disability in pwMS.
AB - Background: The Expanded Disability Status Scale (EDSS) is widely utilized in clinical trials and routine care to evaluate disease burden and progression among people with multiple sclerosis (pwMS). However, instrumental gait measures may be more suitable than EDSS to track walking disability in pwMS. In this cross-sectional study, we aimed to quantify the variability of spatiotemporal gait measures within homologous EDSS categories. Methods: A total of 205 pwMS (age=46.5[SD=10.5] years, 72.2% female, EDSS range=1.0–6.5) were studied in this retrospective analysis. Participants underwent walking assessments through the GAITRite system and the following spatiotemporal gait measures were recorded: gait speed, mean normalized velocity (MNV), base of support, stride length, step length, percentage of gait cycle spent in double support and single support, and functional ambulation profile. The EDSS was evaluated by a certified neurologist. Results: All gait measures exhibited fair to very strong correlations with scores on the EDSS (-0.81≤ρs≤0.25) and poor to fair correlations with disease duration (-0.32≤ρs≤0.17). Overall, the percent variability of gait measures increased across EDSS categories, with coefficients of variation ranging from 6.9% to 37.2% in the minimal disability group (EDSS≤2.5), 8.1% to 33.4% and 22.3% to 53.8% in the moderate (2.54.5) disability groups, respectively. Conclusion: Spatiotemporal gait measures have great variability within homologous EDSS categories. The high percent variability of gait speed and MNV (up to more than 50%) suggests that walking ability varies substantially within and across disability levels. Therefore, in addition to the EDSS, more comprehensive (multidimensional), objective patient-centric metrics would be needed to accurately evaluate disability in pwMS.
KW - Disability
KW - Expanded Disability Status Scale
KW - Gait
KW - Multiple sclerosis
KW - Walking
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UR - http://www.scopus.com/inward/citedby.url?scp=85123916346&partnerID=8YFLogxK
U2 - 10.1016/j.msard.2022.103645
DO - 10.1016/j.msard.2022.103645
M3 - Article
C2 - 35124304
AN - SCOPUS:85123916346
SN - 2211-0348
VL - 59
JO - Multiple Sclerosis and Related Disorders
JF - Multiple Sclerosis and Related Disorders
M1 - 103645
ER -