Ecological validity of walking capacity tests following rehabilitation in people with multiple sclerosis

Abstract

Background Walking capacity tests are commonly used to evaluate interventions aiming at reducing walking impairment in people with multiple sclerosis (pwMS). However, their ecological validity has recently been questioned. The aim of the present study was to investigate the ecological validity of the 2- and 6-minutes walking tests (2MWT and 6MWT) and the timed 25-foot walk (T25FW) after 28 days of multidisciplinary inpatient rehabilitation (MIR) in pwMS using accelerometry. Methods PwMS wore an accelerometer on 7 consecutive days within a 14-day period prior to MIR, performed 2/6MWT and T25FW at the beginning and at the end of MIR, followed by another 7 consecutive days of accelerometry. Results Significant improvements in 2/6MWT and T25FW after MIR in a cohort of 76 pwMS (mean age = 47.9, SD 8.3 years) were overall correlated to a significant gain in everyday life mobility (total steps/day). However, the correlation was strongly dependent on pre-existing walking disability defined by EDSS and only pwMS with “mild” walking impairment (EDSS 2–3.5) were able to transfer benefits measurable by walking capacity tests into improved everyday life mobility, while pwMS with “moderate to severe” walking disability (EDSS 4–6.5) were not. Conclusion Ecological validity of changes in walking capacity tests following MIR is strongly dependent on pre-existing walking impairment.

Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability

“…The results of the current study are in line with those of a similar study by Ehling et al [13], who examined the impact of 28 days of rehabilitation on walking performance, measured in steps per day. The authors reported similar improvements in walking capacity (2MWT +14.8 m) as in the current study, but unchanged steps per day in the subgroup of PwMS with moderate to severe walking impairment, corresponding to an EDSS between 4.0 and 6.5.…”

“…At 3 months’ follow up, motor fatigue and mood were still improved, but PA had declined, compared with before rehabilitation. The improvements seen in the 2MWT (+17m) and TUG (‒2.1 s) exceed the reported minimum for clinically meaningful changes for the 2MWT (+9.1 m) [ 37 ] and the TUG (‒0.75 s) [ 38 ] and are in the range of other rehabilitation studies in MS reporting improvements of 14.8 m (35.1%) [ 13 ] for the 2MWT and ‒1.2 s (‒7.9%) for the TUG [ 39 ]. The improvement in fatigue (FSMC) by ‒6 points (‒9.4%) at the 3-month follow-up is in line with other studies, which showed a decrease in fatigue levels after rehabilitation [ 40 ] of ‒6.1 points (‒12.4%) evaluated with the Modified Fatigue Impact Scale.…”

“…We are unaware of any studies that have prospectively assessed the impact of exercise therapy or rehabilitation on PA in these patients. In a prospective observational study, Ehling et al found that multidisciplinary inpatient rehabilitation in PwMS with moderate to severe walking impairment resulted in improved walking capacity, but not walking performance, measured in steps per day [ 13 ]. However, Ehling et al’s study did not examine PA.…”

Effects of a cooling vest with sham condition on walking capacity in heat-sensitive people with Multiple Sclerosis

“…Most of the previous clinical literature also report physical performance improvements with common tests, such as the Timed Up and Go (TUG), Timed 25-Foot Walk (T25-FW), or the 6-min walking test (6MWT). However, despite being commonly used in clinical and rehabilitation practice, those tests are not strongly reflective of everyday life mobility (Ehling et al 2019), and may be poor estimators of total walking distance in pwMS (Phan-Ba et al 2011). Indeed, although those tests may better at evaluating certain aspects of locomotion (e.g., balance, speed, etc.…”

Making Every Step Count: Minute-by-Minute Characterization of Step Counts Augments Remote Activity Monitoring in People With Multiple Sclerosis

“…Timed 25-Foot Walk [T25FW] test), however, measurement and evaluation of walking performance (i.e. what they actually do in daily life) may be more important to the patient and reflect actual function ( 3 , 4 ).…”