Clinical Importance of Steps Taken per Day among Persons with Multiple Sclerosis

Abstract

BackgroundThe number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in persons with multiple sclerosis (MS).ObjectiveThis study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS.MethodsThis study was a secondary analysis of de-identified data from 15 investigations totaling 786 persons with MS and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences.ResultsThe mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample).ConclusionThe change in motion sensor output of ∼800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS.

Understanding walking activity in multiple sclerosis: step count, walking intensity and uninterrupted walking activity duration related to degree of disability

“…The number of steps taken per day was previously shown to provide a reliable and valid outcome of free-living walking behavior in PwMS [30]. The number found in this study was comparable to previous studies [11,31] while PwMS with mild ambulatory dysfunction made significant more steps than those with a higher disability degree [11,32].…”

Use of Accelerometers to Measure Real-Life Physical Activity in Ambulatory Individuals with Multiple Sclerosis

“…33 Other contributors to decreased PA in MS include fatigue, spasticity, balance difficulties, poor movement coordination, sensory problems, and depression. 34,35 Previous research has shown an inverse relationship between EDSS score and the amount of PA participation, where an increased level of disability as measured by the EDSS score corresponds to less time spent engaged in PA. 36,37 However, some of these studies were conducted with self-reported EDSS scores, 36,38 PatientDetermined Disease Steps scale scores, 39 or PA levels. 40 This study demonstrated that individuals diagnosed as having MS are able to spend time participating in PA of light intensity despite having increased disability as measured by EDSS scores.…”

Motion sensors in multiple sclerosis: Narrative review and update of applications

“…That is, there is evidence that physical activity levels based on steps/day and/or accelerometer counts overall or minutes/day of MVPA decline as MS progresses as a disease [56]. Steps/day from motion sensors further have captured the effect of and recovery from a relapse in persons with MS [80,81]. This suggests that the output from motion sensors may have clinical utility in MS for monitoring disease progression and activity.…”